EndovascularEndovascular treatment of paraclinoid aneurysms
Section snippets
Technique
All the procedures are performed under general anesthesia. After arterial vascular access is obtained, systemic heparinization is given with i.v. heparin, 7000 units bolus followed by 1000 units of heparin per hour.
Patient population
We have reviewed the data of 66 patients with 71 paraclinoid aneurysms that were considered suitable for endovascular therapy between June 1994 and April 1999. There were 56 female and 10 male patients. Mean age was 50.1 years (range 13–75 years). The clinical presentation for the 71 aneurysms included 13 with acute subarachnoid hemorrhage (Table 1), 4 with previous subarachnoid hemorrhage, 6 with visual symptoms from mass effect, and 4 with transient ischemic attacks. Forty-four were
Results
A total of 90 endovascular procedures were performed on the 71 aneurysms. There were 78 coiling procedures, which included 45 procedures using the remodeling technique. Nine permanent balloon occlusions were performed. In addition, there were 3 procedures during which both detachable coils were placed and permanent balloon occlusion was performed.
Fifty-eight aneurysms required only one endovascular procedure each. Nine aneurysms required two endovascular procedures each. Two aneurysms required
Classification of paraclinoid aneurysms
We define paraclinoid aneurysms as those that arise from the internal carotid artery distal to the cavernous sinus and proximal to the posterior communicating artery origin. This section of the carotid artery can be called either the ophthalmic segment or the paraclinoid segment and the aneurysms are variously termed ophthalmic, paraophthalmic, carotid cave, paraclinoid, ventral paraclinoid and superior hypophyseal, superior chiasmatic, lateral chiasmatic, infra chiasmatic, supra chiasmatic,
Conclusion
In conclusion, in a series of 71 aneurysms in 66 patients we were able to treat 61 (86%) by endovascular means. We have demonstrated excellent occlusion (>95%) in 87% of these and <95% occlusion in 13%, with a mortality of 2.2% and a morbidity of 3.3%. There was no morbidity associated with unsuccessful attempts at endovascular therapy. Surgery can be performed in those who have had partial or unsuccessful endovascular therapy; likewise, endovascular therapy may be successful in patients with
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Cited by (68)
Paraclinoid aneurysms: Outcome analysis and technical remarks of a microsurgical series
2022, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :In our practice as in those of other series, the implementation of PED caused a significant decrease in the surgical case volume of paraclinoid aneurysms, especially those electives (Fig. 7). Endovascular coiling, stand-alone, stent-assisted, and balloon-assisted has been related to an occlusion rate significantly lower than both PED and surgery, along with an inferior durability [3,38,44,55,81,90–99] (Table 8). The natural history of paraclinoid aneurysms is characterized by a progressive and slow growing to reach large or giant size without rupture.
Specifics of aneurysm treatment: Paraclinoid internal carotid artery
2018, Intracranial AneurysmsManagement strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms
2015, Clinical Neurology and NeurosurgeryCitation Excerpt :Since the advent of endovascular techniques, excellent results with coil embolization of paraclinoid aneurysms have been reported especially for those lesions with high surgical risk [6,10–13]. However, endovascular treatment (EVT) of aneurysms has been considered as associations with significant problems were faced such as durability of obliteration, thromboembolic complications and hemorrhagic complications related with antithrombotic medications [14–16]. Some reports presented a multidisciplinary approach of microsurgery and EVT for the treatment of paraclinoid aneurysms [6,7,12,17,18].
Bilobulated paraclinoid aneurysm mimics double aneurysms: A comparison of endovascular coiling and surgical clipping treatments
2014, Journal of the Chinese Medical AssociationEndovascular management of cavernous and paraclinoid aneurysms
2014, Neurosurgery Clinics of North AmericaCitation Excerpt :Higher rates of occlusion are obtained with stent-assisted coiling and in smaller aneurysms.6,7,43,45 The overall rate of permanent morbidity and mortality is between 0%–8.3% and 0%–2.2%, respectively, in coiling of paraclinoid aneurysms, and 4% to 7% of patients experience early thromboembolic complications, which often result in only transient morbidity.6,7,45–47 Recurrences occur in between 14% and 17% of those aneurysms treated with coil embolization.7,46