Download PDF
J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 009-014
DOI: 10.1055/s-0037-1604078
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical and Endovascular Treatments for Ruptured Paraclinoid Aneurysms

Shou-sen Wang
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
,
Qing-shuang Zhao
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
,
Jing-fang Hong
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
,
Lin Zhao
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
,
Xiao-jun Zhang
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
,
Ru-mi Wang
1   Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
› Author Affiliations
Further Information

Publication History

19 July 2016

05 April 2017

Publication Date:
25 July 2017 (online)

    Permissions and Reprints

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
 

  • References

  • 1 Sengupta RP, Gryspeerdt GL, Hankinson J. Carotid-ophthalmic aneurysms. J Neurol Neurosurg Psychiatry 1976; 39 (09) 837-853
    CrossrefPubMedGoogle Scholar
  • 2 Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS. Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 2001; 48 (01) 78-89 ; discussion 89–90
    PubMedGoogle Scholar
  • 3 Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Espérance G. Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 1997; 18 (07) 1207-1215
    PubMedGoogle Scholar
  • 4 Drake CG, Vanderlinden RG, Amacher AL. Carotid-ophthalmic aneurysms. J Neurosurg 1968; 29 (01) 24-31
    CrossrefPubMedGoogle Scholar
  • 5 Batjer HH, Kopitnik TA, Giller CA, Samson DS. Surgery for paraclinoidal carotid artery aneurysms. J Neurosurg 1994; 80 (04) 650-658
    CrossrefPubMedGoogle Scholar
  • 6 Day AL. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 1990; 72 (05) 677-691
    CrossrefPubMedGoogle Scholar
  • 7 Ferguson GG, Drake CG. Carotid-ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment. Surg Neurol 1981; 16 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 8 Barami K, Hernandez VS, Diaz FG, Guthikonda M. Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme. Skull Base 2003; 13 (01) 31-41
    PubMedGoogle Scholar
  • 9 Zhao J, Wang S, Zhao Y. , et al. Microneurosurgical management of carotid-ophthalmic aneurysms. J Clin Neurosci 2006; 13 (03) 330-333
    CrossrefPubMedGoogle Scholar
  • 10 Sharma BS, Kasliwal MK, Suri A, Sarat Chandra P, Gupta A, Mehta VS. Outcome following surgery for ophthalmic segment aneurysms. J Clin Neurosci 2010; 17 (01) 38-42
    CrossrefPubMedGoogle Scholar
  • 11 Park HK, Horowitz M, Jungreis C. , et al. Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 2003; 53 (01) 14-23 ; discussion 24
    CrossrefPubMedGoogle Scholar
  • 12 Loumiotis I, D'Urso PI, Tawk R. , et al. Endovascular treatment of ruptured paraclinoid aneurysms: results, complications, and follow-up. AJNR Am J Neuroradiol 2012; 33 (04) 632-637
    CrossrefPubMedGoogle Scholar
  • 13 Xu J, Chen XY, Jiang DY, Li W, Zhang JM. The feasibility and efficacy of endovascular treatment for very small or tiny ruptured paraclinoid aneurysms. Neuroradiology 2013; 55 (01) 77-83
    CrossrefPubMedGoogle Scholar
  • 14 Waldron JS, Halbach VV, Lawton MT. Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion. Neurosurgery 2009; 64 (05) (Suppl. 02) 301-315 ; discussion 315–317
    PubMedGoogle Scholar
  • 15 Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 2000; 31 (10) 2369-2377
    CrossrefPubMedGoogle Scholar
  • 16 Molyneux A, Kerr R, Stratton I. , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360 (9342): 1267-1274
    CrossrefPubMedGoogle Scholar
  • 17 McDougall CG, Spetzler RF, Zabramski JM. , et al. The Barrow Ruptured Aneurysm Trial. J Neurosurg 2012; 116 (01) 135-144
    CrossrefPubMedGoogle Scholar
  • 18 Molyneux AJ, Kerr RS, Yu LM. , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
    CrossrefPubMedGoogle Scholar
  • 19 Spetzler RF, McDougall CG, Albuquerque FC. , et al. The Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg 2013; 119 (01) 146-157
    CrossrefPubMedGoogle Scholar
  • 20 De Jesús O, Sekhar LN, Riedel CJ. Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome. Surg Neurol 1999; 51 (05) 477-487 ; discussion 487–488
    CrossrefPubMedGoogle Scholar
  • 21 Giannotta SL. Ophthalmic segment aneurysm surgery. Neurosurgery 2002; 50 (03) 558-562
    PubMedGoogle Scholar
  • 22 Beretta F, Andaluz N, Zuccarello M. Aneurysms of the ophthalmic (C6) segment of the internal carotid artery: treatment options and strategies based on a clinical series. J Neurosurg Sci 2004; 48 (04) 149-156
    PubMedGoogle Scholar
  • 23 Rubino PA, Mura J, Kitroser M. , et al. Microsurgical clipping of previously coiled aneurysms. World Neurosurg 2014; 82 (1–2): e203-e208
    CrossrefPubMedGoogle Scholar
  • 24 Colli BO, Carlotti Jr CG, Assirati Jr JA, Abud DG, Amato MC, Dezena RA. Results of microsurgical treatment of paraclinoid carotid aneurysms. Neurosurg Rev 2013; 36 (01) 99-114 ; discussion 114–115
    CrossrefPubMedGoogle Scholar
  • 25 Fulkerson DH, Horner TG, Payner TD. , et al. Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: a 16-year experience of a combined neurosurgical and endovascular team. Neurosurgery 2009; 64 (02) 218-229 ; discussion 229–230
    CrossrefPubMedGoogle Scholar
  • 26 Fulkerson DH, Horner TG, Payner TD. , et al. Endovascular retrograde suction decompression as an adjunct to surgical treatment of ophthalmic aneurysms: analysis of risks and clinical outcomes. Neurosurgery 2009; 64 (3, Suppl): ons107-ons111 ; discussion ons111–ons112
    CrossrefPubMedGoogle Scholar
  • 27 Son HE, Park MS, Kim SM, Jung SS, Park KS, Chung SY. The avoidance of microsurgical complications in the extradural anterior clinoidectomy to paraclinoid aneurysms. J Korean Neurosurg Soc 2010; 48 (03) 199-206
    CrossrefPubMedGoogle Scholar
  • 28 Gross BA, Du R. Microsurgical treatment of ophthalmic segment aneurysms. J Clin Neurosci 2013; 20 (08) 1145-1148
    CrossrefPubMedGoogle Scholar
  • 29 Kinouchi H, Yanagisawa T, Suzuki A. , et al. Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms. J Neurosurg 2004; 101 (06) 989-995
    CrossrefPubMedGoogle Scholar
  • 30 Thornton J, Aletich VA, Debrun GM. , et al. Endovascular treatment of paraclinoid aneurysms. Surg Neurol 2000; 54 (04) 288-299
    CrossrefPubMedGoogle Scholar
  • 31 Heran NS, Song JK, Kupersmith MJ. , et al. Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy. J Neurosurg 2007; 106 (06) 968-975
    CrossrefPubMedGoogle Scholar
  • 32 Tenjin H, Takadou M, Ogawa T. , et al. Treatment selection for ruptured aneurysm and outcomes: clipping or coil embolization. Neurol Med Chir (Tokyo) 2011; 51 (01) 23-29
    CrossrefPubMedGoogle Scholar