title: Large paraclinoid aneurysm with a calcified neck treated by tailored multimodality procedures.
abstract: A 68-year-old woman presented with a large paraclinoid aneurysm with a calcified neck causing visual symptoms. Direct clipping was hazardous because of severe calcification of the neck. Endovascular internal trapping was difficult because of the short distance between the neck and the origin of the posterior communicating artery. Proximal occlusion was likely to be less effective because of large collateral back flow to the aneurysm via the ophthalmic artery (OphA). The aneurysm was successfully treated by a combination of a high-flow bypass, intraoperative coil embolization of the parent artery including the origin of the OphA, and clipping of the internal carotid artery distal to the aneurysm. Paraclinoid aneurysms may be difficult to treat by the simple application of direct clipping, endovascular coiling, or trapping. Multimodality procedures can be tailored to treat such aneurysms.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. kikuta@kuhp.kyoto-u.ac.jp
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Kikuta
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000628:therapy*; D002114:Calcinosis / Q000175:diagnosis / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000601:surgery*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D017534:Radial Artery / Q000637:transplantation*