Clinical Outcome of Paraclinoid Internal Carotid Artery Aneurysms After Microsurgical Neck Clipping in Comparison with Endovascular Embolization

다국어 초록 (Multilingual Abstract)

Objective : Because of the complex anatomical association among vascular,dural, and bony structures, paraclinoid internal carotid artery (ICA)aneurysms remain a major challenge for vascular neurosurgeons. Westudied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgicalclipping in comparison with endovascular coiling.
Materials and Methods : Between January 2008 and December 2012, wetreated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascularcoiling. Preoperative neurologic status and postoperative outcomewere evaluated using the Glasgow coma scale (GCS) and themodified Rankin scale (mRS). Postoperative hydrocephalus and vasospasmwere reviewed using the patients' medical charts.
Results : Most patients were in good clinical condition before the operationsand had good treatment outcomes. Clinical vasospasm was observedafter the operation in five patients, and hydrocephalus occurred insix patients. No statistically significant difference regarding aneurysm size,sex, GCS score, H-H grade, and mRS was observed between the surgicalclipping group and the endovascular coiling group. In addition, the treatmentresults and complications did not show statistically significant differencein either group.
Conclusion : Surgical occlusion of paraclinoid ICA aneurysms is difficult;however, no significant differences were observed in the treatment resultsor complications when compared with coil embolization. In particular, useof an adequate surgical technique may lead to better outcomes thanthose for coil embolization in the treatment of large and/or wide-neckparaclinoid ICA aneurysms.

참고문헌 (Reference)

1 Ferrell AS, "Visual complications after stent-assisted endovascular embolization of paraophthalmic and suprasellar variant superior hypophyseal aneurysms: the Duke cerebrovascular center experience in 57 patients" 78 (78): 289-294, 2012

2 Iihara K, "Unruptured paraclinoid aneurysms: a management strategy" 99 (99): 241-247, 2003

3 Kolasa PP, "Treatment of giant paraclinoid aneurysms. Own experience" 25 (25): 287-291, 2004

4 Ogilvy CS, "Surgical management of neurovascular disease" Williams & Wilkins 185-213, 1995

5 Batjer HH, "Surgery for paraclinoid aneurysms" 80 (80): 650-658, 1994

6 Kwon BJ, "Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms" 67 (67): 34-40, 2010

7 Colli BO, "Results of microsurgical treatment of paraclinoid carotid aneurysms" 36 (36): 99-114, 2013

8 Eliava SS, "Results of microsurgical treatment of large and giant ICA aneurysms using the retrograde suction decompression (RSD) technique: series of 92 patients" 73 (73): 683-687, 2010

9 Hoh BL, "Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team" 48 (48): 78-90, 2001

10 Nutik SL, "Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery" 69 (69): 529-534, 1988

11 Barami K, "Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme" 13 (13): 31-41, 2003

12 Giannotta SL, "Ophthalmic segment aneurysm surgery" 50 (50): 558-562, 2002

13 Yadla S, "Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes" 68 (68): 1434-1443, 2011

14 Xu BN, "Microsurgical management of large and giant paraclinoid aneurysms" 73 (73): 137-146, 2010

15 Kim JM, "Microsurgical anatomic features and nomenclature of the paraclinoid region" 46 (46): 670-680, 2000

16 Liu Y, "Microneurosurgical management of the clinoid and paraclinoid aneurysms" 30 (30): 552-556, 2008

17 Zhao J, "Microneurosurgical management of carotid- ophthalmic aneurysms" 13 (13): 330-333, 2006

18 Raco A, "Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery" 108 (108): 1200-1210, 2008

19 Raymond J, "Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils" 1398-1403, 2003

20 Heran NS, "Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endovascular coil therapy" 106 (106): 968-975, 2007

21 Roy D, "Endovascular treatment of unruptured aneurysms" 32 (32): 1998-2004, 2001

22 Loumiotis I, "Endovascular treatment of ruptured paraclinoid aneurysms: results, complications, and follow- up" 33 (33): 632-637, 2012

23 Park HK, "Endovascular treatment of paraclinoid aneurysms: experience with 73 patients" 53 (53): 14-23, 2003

24 Thornton J, "Endovascular treatment of paraclinoid aneurysms" 54 (54): 288-299, 2000

25 Roy D, "Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils" 18 (18): 1207-1215, 1997

26 Fulkerson DH, "Endovascular retrograde suction decompression as an adjunct to surgical treatment of ophthalmic aneurysms: analysis of risks and clinical outcomes" 64 (64): ons107-ons111, 2009

27 Fernandez Zubillaga A, "Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results" 15 (15): 815-820, 1994

28 Khan N, "Conventional microsurgical treatment of paraclinoid aneurysms : state of the art with the use of the selective extradural anterior clinoidectomy SEAC" 94 : 23-29, 2005

29 Morgan MK, "Commentary: paraclinoid carotid aneurysms" 18 (18): 23-, 2011

30 De Jesus O, "Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome" 51 (51): 477-487, 1999

31 진성철, "Clinical and Radiogical Outcomes of Endovascular Detachable Coil Embolization in Paraclinoid Aneurysms : A 10-Year Experience" 대한신경외과학회 45 (45): 5-10, 2009

32 Nutik S, "Carotid paraclinoid aneurysms with intradural origin and intracavernous location" 48 (48): 526-533, 1978

33 Day AL, "Aneurysms of the ophthalmic segment. A clinical and anatomical analysis" 72 (72): 677-691, 1990

34 Beretta F, "Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series" 48 (48): 149-156, 2004

35 Dolenc VV, "A combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain" 72 : 89-97, 1999

36 Arnautovic KI, "A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms" 50 (50): 504-518, 1998