Visual outcomes after surgery for paraclinoid aneurysms: A fujita experience

Abstract

Introduction: The surgical strategies for clipping of paraclinoid aneurysms are diverse. These aneurysms are unique in their location, as they closely abut the anterior clinoid process (ACP) and the optic nerve. The ultimate goal of clipping encompasses the exposure of neck of the aneurysm which is seldom complete without the manipulation of optic nerve and the ACP. This manipulation may result in disturbances of vision postoperatively. We analyze our results of visual outcomes in the surgery for paraclinoid aneurysms in this retrospective study. Materials and Methods: All patients with paraclinoid aneurysms who underwent surgery from June 2014 to June 2019 were included in the study. Surgical procedure was uniform in all patients which included anterior clinoidectomy and clipping of aneurysms as per the Bantane protocol. Glasgow Outcome Scale as well as vision was assessed at discharge and at 1 month and 6 months. Results: There were 77 cases of paraclinoid aneurysms operated during the abovementioned period. All patients had no symptoms related to vision preoperatively. Visual deterioration was noted in two patients. All patients were discharged with a good outcome on the Glasgow Outcome Scale. Conclusion: Paraclinoid aneurysm has a good outcome when treated with surgery. The visual deterioration following surgery can be minimized with extradural anterior clinoidectomy and careful handling of the vessels and nerve.

Microsurgical treatment of ophthalmic artery aneurysm, a case series of 55 patients with long-term follow-up

“…Paraclinoidal zone surgery especially anterior clinoidectomy requires specific surgical expertise to preserve neural and vascular structures. post operation visual loss is an unpleasant complication of anterior clinoidectomy which is being performed in a microsurgical approach [ 4 ]. Ophthalmic artery aneurysm microsurgical obliteration in the hands of an experienced neurosurgeon and well-equipped facility will result in excellent outcomes [ 3 ].…”

“…In general, microsurgery is used for medium-sized vessels, especially in distal arterioles which EV access is technically challenging. Hematoma evacuation, lower risk of treatment failure, lower recurrence rate, and better bleeding control are important advantages of microsurgical approaches in comparison to EV for aneurysm obliteration [ 4 ]. In anatomical complex regions such as paraclinoidal segment aneurysms, tortuous and complex vascular anatomy makes the EV challenging while MS provides great anatomical visualization, safe vascular exposure, and effective postoperative outcomes.…”

“…In anatomical complex regions such as paraclinoidal segment aneurysms, tortuous and complex vascular anatomy makes the EV challenging while MS provides great anatomical visualization, safe vascular exposure, and effective postoperative outcomes. Compared to endovascular techniques, direct decompression of neural structure following the microsurgical approaches, is extremely beneficial for neurological recovery [ 4 ].…”

Visual Evoked Potential Can Predict Deterioration of Visual Function After Direct Clipping of Paraclinoid Aneurysm With Anterior Clinoidectomy

“…The surgical outcome of paraclinoid ICA aneurysm was generally favorable other than the visual outcome. 6,7 Some researchers reported excellent visual outcomes, 8,9 whereas moderate visual impairment is often subjectively asymptomatic and can be revealed for the first time after ophthalmological examination. Postoperative visual acuity (VA) loss (VAL) or visual field (VF) loss (VFL) including moderate visual impairment occurred in approximately 30% of the patients.…”