Surgical nuances of giant paraclinoid aneurysms

Figueiredo, Eberval Gadelha; Tavares, Wagner Malagó; Rhoton, Albert L.; Oliveira, Evandro de

doi:10.1007/s10143-009-0224-2

Cited by 22 publications

(12 citation statements)

References 20 publications

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“…The use of endovascular therapy in the treatment of large paraclinoid aneurysms is limited due to the superiority of the microsurgical treatment, which allows for greater durability, increased ability to ablate an associated mass effect, and decreased cost. Microsurgery of large/giant broad-neck paraclinoid aneurysms is the preferred method of treatment5,9,18,22,35).…”

Section: Discussionmentioning

confidence: 99%

“…These paraclinoid aneurysms are classified based on complex relationships between the aneurysm sac, dura, branching arteries, and anterior clinoid process2,3,8,14,18,19,28,29). Advancements in endovascular and microsurgical techniques have substantially improved the completeness of aneurysm sac obliteration operations and the treatment outcomes of paraclinoid aneurysms5,8,9,15,16,18,30,33,35,39). However, because of the incredibly complex neuroanatomical relationship between bone, neural, and vascular structures around this paraclinoid area evidenced by high rates of surgical morbidity and mortality, direct microsurgical occlusion for large and giant paraclinoid aneurysms have remained a great challenge for vascular neurosurgeons.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, in spite of recent endovascular technique improvements, large and giant aneurysms at this specific site often occlude incompletely or recur due to neck broadness33,34). Literature on the surgical results of large aneurysms in this unique anatomical area is limited5,7,9,18,22,30,32,35,39).…”

Section: Introductionmentioning

confidence: 99%

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Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

Lee

Kim

2013

J Korean Neurosurg Soc

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ObjectiveAlthough surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications.MethodsBetween September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography.ResultsOf the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely.ConclusionThe key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

Lee

Kim

2013

J Korean Neurosurg Soc

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“…Even in best hands, the techniques of clipping or vessel anastomosis continue to have a high morbidity and mortality risk. [23] Ophthalmic artery aneurysms pose particular challenges to both neurosurgeon and interventional radiologist. Modern embolization techniques proved safe and effective, raising the survival and the quality of life for ophthalmic artery aneurysms patients; thus, it has become the standard of care.…”

Section: Introductionmentioning

confidence: 99%

“…Modern embolization techniques proved safe and effective, raising the survival and the quality of life for ophthalmic artery aneurysms patients; thus, it has become the standard of care. [2] Nevertheless, there are cases where embolization is impossible to perform or is fraught with unacceptable danger (giant lesions, ICA abnormalities), and a swift microsurgical solution is needed.…”

Section: Introductionmentioning

confidence: 99%

Challenges in a case of ophthalmic artery aneurysm associated with abnormal internal carotid arteries

Dinca

Brehar²,

Giovani³

et al. 2017

Asian J Neurosurg

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Ophthalmic artery aneurysms account for 5% of all cerebral aneurysms and are an important cause of morbidity and mortality related to subarachnoid hemorrhage. The diagnosis is often made only when the aneurysm is large enough to become symptomatic. They remain technically challenging for both neurosurgeon and interventional radiologist. We present the case of a 62-year-old woman admitted for transient loss of consciousness, followed by generalized tonic-clonic seizures. Computed tomography (CT) showed a subarachnoid hemorrhage (SAH), clinically graded as Hunt and Hess III. Magnetic resonance imaging (angioMR) and the four-vessel digital subtraction angiography (DSA) identified a ruptured, 8 mm left ophthalmic artery aneurysm. Embolization was the first therapeutic choice. Nevertheless, the attempt had to be aborted due to a combination of a hypoplastic right internal carotid artery (ICA) and an irregular atheromatous plaque on the left ICA, rendering the procedure unduly hazardous. Therefore, microsurgical clipping of the aneurysm became the procedure of choice. Postoperatively, the patient was in good condition, with no visual and neurological deficits. At 6 months follow up, she was assigned maximum scores of 5 and 8 on the Glasgow Outcome Scale (GOS) and Extended GOS (GOS-E), respectively. Aneurysm rupture represents a neurosurgical emergency and an early intervention (less than 48 h) is recommended to maximize the chances of deficit-free survival. The peculiarities of this case consisted in the combination between the size and the location of the aneurysm, abrupt presentation, and the impossibility of embolization due to bilateral ICA abnormalities, congenital (hypoplastic right ICA) and acquired (extensively atherosclerotic left ICA).

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Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms

Pasqualin

Meneghelli

Cozzi

et al. 2016

Acta Neurochirurgica Supplement

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Surgery on paraclinoid carotid aneurysms is technically demanding and entails considerable risks, especially to visual function. The aim of this study was to evaluate the clinical and visual outcome after surgery in 66 patients with paraclinoid carotid aneurysms (30 ruptured and 36 unruptured) treated between 1990 and 2014. Thirty-six aneurysms were of standard size, and 30 were large (16-20 mm) or giant (>20 mm); the Barami classification was used in every case. During surgery, multiple clips were needed in 25 % of patients with standard, and in 80 % of patients with large-giant aneurysms; temporary carotid occlusion was performed on 11 % of patients with standard and 63 % with large-giant aneurysms. Postoperatively, a cerebrospinal fluid fistula was repaired surgically in two patients. At the 3-month follow-up, the modified Rankin Score (mRS) was favorable (0-2) in 63 % of patients with ruptured and in 97 % with unruptured aneurysms; four patients presenting with large hematomas died. Postoperative visual impairment (worsening or newly developing deficit) was noted in 25 % of cases with standard and 14 % of cases with large-giant ruptured aneurysms, and, respectively, in 10 % with standard and 31 % with large-giant unruptured aneurysms. It has been concluded that surgery remains a reasonable choice in the management of patients with paraclinoid carotid aneurysms.

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Surgical nuances of giant paraclinoid aneurysms

Cited by 22 publications

References 20 publications

Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

Challenges in a case of ophthalmic artery aneurysm associated with abnormal internal carotid arteries

Outcome After Surgical Treatment of Paraclinoid Carotid Aneurysms

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