J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):225-234. 10.7461/jcen.2014.16.3.225.

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

• Bae DH
• Kim JM
• Won YD
• Choi KS
• Cheong JH
• Yi HJ
• Kim CH

• KMID: 1963160
• DOI: http://doi.org/10.7461/jcen.2014.16.3.225

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. We studied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgical clipping in comparison with endovascular coiling.
MATERIALS AND METHODS
Between January 2008 and December 2012, we treated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascular coiling. Preoperative neurologic status and postoperative outcome were evaluated using the Glasgow coma scale (GCS) and the modified Rankin scale (mRS). Postoperative hydrocephalus and vasospasm were reviewed using the patients' medical charts.
RESULTS
Most patients were in good clinical condition before the operations and had good treatment outcomes. Clinical vasospasm was observed after the operation in five patients, and hydrocephalus occurred in six patients. No statistically significant difference regarding aneurysm size, sex, GCS score, H-H grade, and mRS was observed between the surgical clipping group and the endovascular coiling group. In addition, the treatment results and complications did not show statistically significant difference in either group.
CONCLUSION
Surgical occlusion of paraclinoid ICA aneurysms is difficult; however, no significant differences were observed in the treatment results or complications when compared with coil embolization. In particular, use of an adequate surgical technique may lead to better outcomes than those for coil embolization in the treatment of large and/or wide-neck paraclinoid ICA aneurysms.

Keyword

Paraclinoid aneurysms; Microsurgical clipping; Endovascular coiling; Outcome

MeSH Terms

Aneurysm*
Carotid Artery, Internal*
Embolization, Therapeutic
Glasgow Coma Scale
Humans
Hydrocephalus
Neck*
Surgical Instruments

Figure

• 

  Fig. 1 Preoperative left digital subtraction angiography (DSA) (A, B) representing a giant left internal carotid artery (ICA) posterior wall aneurysm. (A) Anteroposterior view. (B) Anterooblique view of three-dimensional (3-D) DSA. (C) 3-D computed tomographic (CT) angiography showing a giant sac adhering to all of the surrounding anterior and posterior cerebral arteries on both sides. Postoperative DSA (D, E) representing complete obliteration of the giant aneurysm sac and reconstruction of the ICA using eight different shapes of fenestrated clips. (D) Anteroposterior view (E) Lateral view of 3-D DSA. (F) Postoperative 3-D CT angiography.

• 

  Fig. 2 Preoperative left digital subtraction angiography (DSA) (A, B) representing a left ophthalmic artery aneurysm. (A) Lateral view. (B) Lateral view of 3-D DSA. (C) Lateral view. Coil embolization was performed without using a stent. Postoperative left DSA (C) representing complete coil packing of the left ophthalmic artery aneurysm and showing that left ophthalmic artery flow was well preserved.

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