title: Risk Factors for Visual Impairments in Patients with Unruptured Intradural Paraclinoid Aneurysms Treated by Neck Clipping without Bypass Surgery.
abstract: OBJECTIVE
  Although paraclinoid aneurysms are now frequently referred for endovascular treatment, the durability of obliteration is still to be determined. Therefore, direct surgery for paraclinoid aneurysms still remains indispensable. The present study aimed to evaluate the risk factors for the visual impairments in patients with unruptured intradural paraclinoid aneurysms.
  
  
  METHODS
  The data of 133 patients with 136 aneurysms treated by neck clipping without bypass surgery was evaluated. Visual impairments included decreased visual acuity and visual field defect. The aneurysm was classified into superior projecting aneurysm, ventral projecting aneurysm, and carotid cave aneurysm. Plug-in method was defined as filling interspace, which was formed between the internal carotid artery and the sutured dura in case of detachment of the dural ring.
  
  
  RESULTS
  Postoperative new visual impairments were observed in 30 aneurysms (22%). During the follow-up period (median, 600 days), postoperative new visual impairments continued in 23 aneurysms (17%). Multivariate analysis showed that carotid cave location and plug-in method were related to new visual impairments at 30 days (odds ratio [OR], 2.6; 95% confidence interval [CI] 1.1-6.1; P = 0.031 and OR, 4.1; 95% CI 1.4-12; P = 0.008) and at 6 months (OR, 4.1; 95% CI 1.5-11; P = 0.005 and OR, 3.3; 95% CI 1.1-11; P = 0.045).
  
  
  CONCLUSIONS
  The present study showed that carotid cave location and plug-in method during dural closures were related to postoperative continued visual impairments. Neurosurgeons should carefully consider the surgical indication for unruptured carotid cave aneurysms and avoid plug-in methods.
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan. Electronic address: nowornever1982@gmail.com.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rihei
authors.initials: R
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology*
keywords: Neck clipping; Paraclinoid aneurysm; Risk factors; Visual impairments