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.


MATERIAL AND 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).


CONCLUSION
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.
['Matano|Fumihiro|F|', 'Tanikawa|Rokuya|R|', 'Kamiyama|Hiroyasu|H|', 'Ota|Nakao|N|', 'Tsuboi|Toshiyuki|T|', 'Noda|Kosumo|K|', 'Miyata|Shiro|S|', 'Matsukawa|Hidetoshi|H|', 'Murai|Yasuo|Y|', 'Morita|Akio|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002340:Carotid Artery Diseases D002533:Cerebral Angiography D002548:Cerebral Revascularization D005260:Female D005500:Follow-Up Studies D006801:Humans D021621:Imaging, Three-Dimensional D002532:Intracranial Aneurysm D008026:Ligation D008297:Male D008866:Microsurgery D008875:Middle Aged D020768:Middle Cerebral Artery D011183:Postoperative Complications D012189:Retrospective Studies D019291:Skull Base D013525:Surgical Instruments D013699:Temporal Arteries D014057:Tomography, X-Ray Computed D055815:Young Adult
Paraclinoid aneurysm High-flow bypass Anterior clinoidectomy Clipping