Paraclinoid carotid aneurysms

Superior Hypophyseal Artery Aneurysms Have the Lowest Recurrence Rate with Endovascular Therapy

“…They arise from the internal carotid artery between the origins of the ophthalmic and the posterior communicating arteries and project medially. 1 Consequently, these aneurysms are intradural and may result in subarachnoid hemorrhage. SHA aneurysms have also been classified as paraclinoid aneurysms along with carotid cave, carotid ophthalmic, and posterior carotid wall aneurysms.…”

Commentary: Paraclinoid carotid aneurysms

“…Javalkar et al, 1 in this issue of the Journal of Clinical Neuroscience, have provided an excellent analysis of the current thinking regarding management of paraclinoid aneurysms and ophthalmic aneurysms, by both endovascular and surgical techniques. However, this comprehensive analysis and classification, in my view, overcomplicates the treatment of these aneurysms and may create fear that these aneurysms are of such complexity that they should be always considered first for endovascular repair.…”

“…From my experience, the risk associated with repairing these aneurysms is no greater than other locations (with a 6.5% risk of a new permanent deficit resulting in a permanent reduction in modified Rankin Score of greater than 1, including a 1.1% mortality due to surgery). The decision-making that I apply is far simpler than outlined in the article by Javalkar et al 1 Aneurysms that do not require intervention are judged on the same basis as other aneurysms. If the judgment is that the aneurysm should be repaired and if the aneurysm is of appropriate size and neck to repair by clip reconstruction (and this is judged on the same basis as an aneurysm of any location) then this is what is done.…”

Experiences and complications in endovascular treatment of paraclinoid aneurysms

“…1 Surgical clipping of these aneurysms remains a technical challenge due to the particular features of their location, including the adjacent bony anatomy, dural attachment and close relationship with the optic nerves. 1 Because of the complexity and difficulty associated with direct surgical clipping, endovascular procedures have been increasingly used to treat these aneurysms.…”

“…1 Surgical clipping of these aneurysms remains a technical challenge due to the particular features of their location, including the adjacent bony anatomy, dural attachment and close relationship with the optic nerves. 1 Because of the complexity and difficulty associated with direct surgical clipping, endovascular procedures have been increasingly used to treat these aneurysms. [2][3][4][5][6][7] However, endovascular treatment of paraclinoid aneurysms may also be technically difficult as they can project in various directions and occur in combination with the tortuous carotid siphon, 4,7 thus only a limited number of published studies concerning the results and complications of this treatment have been reported.…”