Abstract
Background The treatment of paraclinoid aneurysms can be challenging due to their relationship
to the cavernous sinus, carotid siphon, and optic nerve. The goal of this retrospective
analysis is to compare the efficacy and safety of microsurgical versus endovascular
treatments for ruptured paraclinoid aneurysms.
Methods Medical records were reviewed to collect information about patient demographics,
risk factors, diagnosis (the position and size of aneurysms), Hunt and Hess grade,
and surgical method and outcomes, including modified Rankin Scale (mRS) at the time
of discharge and 6 months later, complications, and death.
Results In total, 15 and 6 patients were recruited into the microsurgery and endovascular
groups, respectively. No difference was detected regarding age, sex, risk factors,
and Hunt and Hess grade. Most patients had ophthalmic segment aneurysms (87% versus
83%; p = 1.000) and small aneurysms (< 10 mm, 67% versus 100%; p = 0.102). In the microsurgical group, five patients (33%) had large aneurysms (10–25
mm); three patients (20%) had multiple aneurysms (all p > 0.05 compared with the endovascular group). The occlusion rate at 6 months was
93% in the microsurgical group and 100% in the endovascular group (p > 0.05). No difference was found regarding mRS or the complication and mortality
rates between the two groups (all p > 0.05). The occurrence of complications was not related to the location and size
of aneurysms (all p > 0.05).
Conclusions Our retrospective analysis indicates that good clinical outcomes can be achieved
with both microsurgical and endovascular approaches. But further prospective randomized
multicenter studies are needed to provide more evidence for clinical practice.
Keywords
endovascular - microsurgery - paraclinoid aneurysm - ruptured
