Outcome of the Microsurgical Treatment of 221 Paraclinoid Aneurysms

We present our experience with the management of 325 paraclinoid aneurysms. 62 out of 325 (19%) were treated conservatively.

Methods: A pretemporal predominantly extradural approach and wide exposure of the paraclinoid region was used in each patient. The microsurgical outcome of 221 clipped aneurysms was evaluated including Rankin scales and visual outcome obtained post-operatively, 6 months and one year. Data was prospectively collected and retrospectively analyzed.

Results: 263 patients received treatment (clipping = 221, wrapping = 17, trapping = 4, endovascular = 32, EC-IC bypass = 5). Female/male ratio = 6.5/1. Median age 54 (average 53.7). 30 of the microsurgically clipped patients presented with rupture and 191 with unrupture. (55% were superior 26% inferior 9% lateral, 10% medial). Perioperative mortality was 7% for the ruptured group and 0% for the unruptured. mRs 0–1 was 93% at DC and 99% at six months to one year for the unruptured group for an average hospital stay of 3.5 with +/− 1. Residual aneurysm due to calcification occurred in 3 with no regrowth or recurrence. Visual worsening occurred in 8 patients with significant permanent deficits in only 2 of the first 100 cases and with improvement in the others.

Advances in the in-depth understanding of microsurgical anatomy of the clinoid region makes microsurgical clipping of paraclinoid aneurysms possible, very safe and presents patients with the most durable and curable treatment modality.