Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms

Clin Neurol Neurosurg. 2015 Jan:128:72-7. doi: 10.1016/j.clineuro.2014.11.008. Epub 2014 Nov 15.


Objective: Advances in endovascular treatment (EVT) have greatly improved the treatment outcomes of paraclinoid aneurysms. However, EVT had the shortcoming of durability and thromboembolic complications. As well, surgical treatment of paraclinoid aneurysms is still challenging due to the complexity of adjacent structures. The objective of this study is to report our experience with a combined surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms.

Methods: A retrospective review was conducted of 185 cases of unruptured paraclinoid aneurysms that underwent surgical or endovascular treatment between September 2008 and August 2012. Thirty-one aneurysms (16.8%) were treated by microsurgery and 154 (83.2%) were treated by EVT. Fifty aneurysms (27.0%) were classified to the dorsal group and 135 (73%) were classified to the non-dorsal group.

Results: Twenty of 50 dorsal group aneurysms (40%) were treated by microsurgery while 124 of 135 non-dorsal group aneurysms (91.9%) underwent an EVT. The rate of complete occlusion was 96.8% in surgical series and 60.4% in EVT (P < 0.001). Recanalization occurred in 9 aneurysms (5.8%) of EVT and 1 aneurysm (3.2%) of surgical series (P = 0.360). In non-dorsal group, transient complications (10 aneurysms (5.4%), P = 0.018) and morbidity at last visiting (6 aneurysms (3.2%), P = 0.021) were more present in surgically treated cases rather than in EVT cases. Diplopia and visual field defect occurred in the non-dorsal group only; in 2 of 11 surgical cases (18.2%) and in 1 of 124 EVT series (0.8%) (P = 0.017). The overall rate of excellent or good clinical outcomes (Glasgow outcome scale 5 or 4) was 98.9%.

Conclusion: EVT is a safe and effective treatment for the non-dorsal group. Based on angiographic and clinical aspects, microsurgical clipping has prior efficacy with better outcomes in the dorsal group under proper individualized selection.

Keywords: Endovascular treatment; Microsurgical treatment; Paraclinoid aneurysm.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carotid Artery Diseases / pathology
  • Carotid Artery Diseases / surgery
  • Carotid Artery Diseases / therapy*
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery
  • Intracranial Aneurysm / therapy*
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome