title: Exclusively intradural exposure and clip reconstruction in complex paraclinoid aneurysms.
abstract: BACKGROUND
  The management of complex paraclinoid aneurysms is still challenging. In this article we describe our approach to paraclinoid aneurysms, which has evolved over several years, using an exclusively intradural approach.
  
  
  METHODS
  All procedures are done under continuous electrophysiological monitoring. A standard pterional approach is used to access the paraclinoid region exclusively intraduraly. After optic nerve unroofing and tailored clinoidectomy, the aneurysm neck is visualized and clipped using the tandem clipping technique and suction decompression if necessary. Aneurysm occlusion is verified using intraoperative ICG angiography and postoperative 3D DSA.
  
  
  CONCLUSIONS
  The exclusively intradural approach to complex paraclinoid aneurysms with tailored clinoidectomy offers an excellent surgical corridor for the treatment of these challenging lesions.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. v.seifert@em.uni-frankfurt.de
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
mesh_terms: D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000601:surgery; D013525:Surgical Instruments / Q000592:standards*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*