Experiences and complications in endovascular treatment of paraclinoid aneurysms

Chen, Zhi; Yang, Yuan; Miao, Hongpin; Li, Fēi; Zhang, Jianbo; Feng, Hua; Zhu, Gang

doi:10.1016/j.jocn.2012.09.043

Cited by 7 publications

(2 citation statements)

References 16 publications

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“…11 Moreover, small perforating branches may not be visible on the angiogram, and the sacrifice of these branches may cause ischemic complications. [12][13][14] Furthermore, endovascular treatment does not relieve the mass effect on the optic nerve caused by the aneurysm.…”

Section: Necessity Of Open Surgery In Paraclinoid Aneurysmsmentioning

confidence: 99%

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

Zhao¹,

Meybodi²,

Labib³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEAneurysms that arise on the medial surface of the paraclinoid segment of the internal carotid artery (ICA) are surgically challenging. The contralateral interoptic trajectory, which uses the space between the optic nerves, can partially expose the medial surface of the paraclinoid ICA. In this study, the authors quantitatively measure the area of the medial ICA accessible through the interoptic triangle and propose a potential patient-selection algorithm that is based on preoperative measurements on angiographic imaging.METHODSThe contralateral interoptic trajectory was studied on 10 sides of 5 cadaveric heads, through which the medial paraclinoid ICA was identified. The falciform ligament medial to the contralateral optic canal was incised, the contralateral optic nerve was gently elevated, and the medial surface of the paraclinoid ICA was inspected via different viewing angles to obtain maximal exposure. The accessible area on the carotid artery was outlined. The distance from the distal dural ring (DDR) to the proximal and distal borders of this accessible area was measured. The superior and inferior borders were measured using the clockface method relative to a vertical line on the coronal plane. To validate these parameters, preoperative measurements and intraoperative findings were reviewed in 8 clinical cases.RESULTSIn the sagittal plane, the mean (SD) distances from the DDR to the proximal and distal ends of the accessible area on the paraclinoid ICA were 2.5 (1.52) mm and 8.4 (2.32) mm, respectively. In the coronal plane, the mean (SD) angles of the superior and inferior ends of the accessible area relative to a vertical line were 21.7° (14.84°) and 130.9° (12.75°), respectively. Six (75%) of 8 clinical cases were consistent with the proposed patient-selection algorithm.CONCLUSIONSThe contralateral interoptic approach is a feasible route to access aneurysms that arise from the medial paraclinoid ICA. An aneurysm can be safely clipped via the contralateral interoptic trajectory if 1) both proximal and distal borders of the aneurysm neck are 2.5–8.4 mm distal to the DDR, and 2) at least one border of the aneurysm neck on the coronal clockface is 21.7°–130.9° medial to the vertical line.

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Section: Necessity Of Open Surgery In Paraclinoid Aneurysmsmentioning

confidence: 99%

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

Zhao¹,

Meybodi²,

Labib³

et al. 2021

Journal of Neurosurgery

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“…Park, CA) was approved by the FDA for treatment of large or giant wide-neck intracranial aneurysms in the proximal intracranial ICA, including the ophthalmic segment 1,13,16,17 . Good results have been published in the literature with the use of FDS, with occlusion rates of up to 90% and complications lower than 5%, however surgical clipping remains an acceptable option to achieve high occlusion rates with average complications 1,2,3,4,5,18,19,20 .…”

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confidence: 99%

Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

Pahl

Oliveira

Brock

et al. 2016

Arq. Neuro-Psiquiatr.

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Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

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Paraclinoid Aneurysms: Flow Diverters and Endovascular Treatment

Sonig

Hopkins

Snyder

et al. 2016

Controversies in Vascular Neurosurgery

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Experiences and complications in endovascular treatment of paraclinoid aneurysms

Cited by 7 publications

References 16 publications

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

Paraclinoid Aneurysms: Flow Diverters and Endovascular Treatment

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