title: Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms.
abstract: OBJECTIVE
  Advances in endovascular treatment (EVT) have greatly improved the treatment outcomes of paraclinoid aneurysms. However, EVT had the shortcoming of durability and thromboembolic complications. As well, surgical treatment of paraclinoid aneurysms is still challenging due to the complexity of adjacent structures. The objective of this study is to report our experience with a combined surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms.
  
  
  METHODS
  A retrospective review was conducted of 185 cases of unruptured paraclinoid aneurysms that underwent surgical or endovascular treatment between September 2008 and August 2012. Thirty-one aneurysms (16.8%) were treated by microsurgery and 154 (83.2%) were treated by EVT. Fifty aneurysms (27.0%) were classified to the dorsal group and 135 (73%) were classified to the non-dorsal group.
  
  
  RESULTS
  Twenty of 50 dorsal group aneurysms (40%) were treated by microsurgery while 124 of 135 non-dorsal group aneurysms (91.9%) underwent an EVT. The rate of complete occlusion was 96.8% in surgical series and 60.4% in EVT (P < 0.001). Recanalization occurred in 9 aneurysms (5.8%) of EVT and 1 aneurysm (3.2%) of surgical series (P = 0.360). In non-dorsal group, transient complications (10 aneurysms (5.4%), P = 0.018) and morbidity at last visiting (6 aneurysms (3.2%), P = 0.021) were more present in surgically treated cases rather than in EVT cases. Diplopia and visual field defect occurred in the non-dorsal group only; in 2 of 11 surgical cases (18.2%) and in 1 of 124 EVT series (0.8%) (P = 0.017). The overall rate of excellent or good clinical outcomes (Glasgow outcome scale 5 or 4) was 98.9%.
  
  
  CONCLUSIONS
  EVT is a safe and effective treatment for the non-dorsal group. Based on angiographic and clinical aspects, microsurgical clipping has prior efficacy with better outcomes in the dorsal group under proper individualized selection.
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Republic of Korea.
authors.forename: Se-Yang
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Kwan Sung
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea. Electronic address: nsshin@gmail.com.
authors.forename: Yong Sam
authors.initials: YS
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Endovascular treatment; Microsurgical treatment; Paraclinoid aneurysm