Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome.
BACKGROUND
Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass.


METHODS
We retrospectively analyzed findings from 127 consecutive patients (19 males, mean age at surgery: 56.8 years, range: 19-81 years) at our hospital. The size of aneurysms ranged from 2.7-43.2 mm (mean: 6.9 mm). Extradural anterior clinoidectomy was used to clip small aneurysms. As large or giant aneurysms required a longer temporal occlusion period and often could not undergo simple clipping, high-flow bypass with anterior clinoidectomy or cervical internal carotid ligation was performed to reduce aneurysm blood flow and induce thrombosis. We reviewed a postoperative modified Rankin Scale (mRS), radiographic outcomes, cerebral infarction, and visual disturbance. In addition, we analyzed factors relating to the outcomes and complications, with focus on the aneurysm size, location, and type of surgical treatment.


RESULTS
Good outcomes were achieved in all patients, as follows: mRS 0:100, mRS 1:16, mRS 2:11, and mRS 3-6:0. Among the 127 patients, complete exclusion of aneurysm was achieved in 119 cases (93.7%). Postoperative morbidity included ischemic lesions in 11 (8.6%) and visual disturbance in 24 (18.8%). Significant statistical differences were observed between ischemic complication and aneurysm size and location (P = 0.0001) and surgical treatment (P < 0.0001).


CONCLUSIONS
Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan; Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: s00-078@nms.ac.jp.
Fumihiro
F
Matano
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Rokuya
R
Tanikawa
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Hiroyasu
H
Kamiyama
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Nakao
N
Ota
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Toshiyuki
T
Tsuboi
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Kosumo
K
Noda
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Shiro
S
Miyata
Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
Hidetoshi
H
Matsukawa
Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Yasuo
Y
Murai
Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Akio
A
Morita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008026:Ligation; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013525:Surgical Instruments; D013699:Temporal Arteries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Anterior clinoidectomy; Clipping; High-flow bypass; Paraclinoid aneurysm