Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery

Antonino Raco, Alessandro Frati, Antonio Santoro, Tommaso Vangelista, Maurizio Salvati, Roberto Delfini, Giampaolo Cantore

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Object. Because of the anatomical complexity of the paraclinoid region, the surgical treatment of aneurysms arising in the C6 segment of the internal carotid artery is extremely challenging. The authors' aim in this study was to describe the extended clinical follow-up and assess the short-term and long-term effectiveness of surgical treatment for these aneurysms, focusing on the clinical outcome and degree of aneurysm occlusion and recurrence. Methods. The authors retrospectively analyzed the clinical records for patients treated surgically between 1973 and 2004 at the University of Rome, "La Sapienza." Aneurysms were classified into the following 3 groups according to the site where they arose: the anteromedial, anterior or anterolateral, and posteromedial wall of the C6 segment. Results. Of the 108 aneurysms in 104 patients treated, 63 (58%) were large or giant. Eighty-eight aneurysms in 84 patients were clipped, 16 underwent a high-flow bypass, 2 were trapped, 1 was wrapped, and 1 was left untreated. The mean follow-up was 126 months; 47 patients had a follow-up of > 10 years. Of the 88 aneurysms that were clipped, 6 (6.8%) had an incomplete occlusion that required an immediate reoperation in 1 case and at 2 years in another. Overall 6 patients (5.8%) had surgery-related permanent complications. Conclusions. Mortality and morbidity rates depend mainly on the patient's preoperative Hunt and Hess grade subarachnoid hemorrhage, whereas surgical morbidity principally reflects excessive manipulation of the optic nerve or ischemic problems due to excessive temporary trapping undertaken without adequate neuroprotection. In expert hands, surgery (clipping and bypass procedures) is a definitive treatment for C 6 aneurysms and has an acceptable complication rate.

Original languageEnglish
Pages (from-to)1200-1210
Number of pages11
JournalJournal of Neurosurgery
Volume108
Issue number6
DOIs
Publication statusPublished - Jun 2008

Fingerprint

Carotid Arteries
Aneurysm
Morbidity
Internal Carotid Artery
Subarachnoid Hemorrhage
Optic Nerve
Reoperation
Hand
Recurrence
Mortality
Therapeutics

Keywords

  • Aneurysm
  • Carotid artery
  • Long-term follow-up
  • Ophthalmic segment
  • Surgical treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery. / Raco, Antonino; Frati, Alessandro; Santoro, Antonio; Vangelista, Tommaso; Salvati, Maurizio; Delfini, Roberto; Cantore, Giampaolo.

In: Journal of Neurosurgery, Vol. 108, No. 6, 06.2008, p. 1200-1210.

Research output: Contribution to journalArticle

Raco, A, Frati, A, Santoro, A, Vangelista, T, Salvati, M, Delfini, R & Cantore, G 2008, 'Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery', Journal of Neurosurgery, vol. 108, no. 6, pp. 1200-1210. https://doi.org/10.3171/JNS/2008/108/6/1200
Raco, Antonino ; Frati, Alessandro ; Santoro, Antonio ; Vangelista, Tommaso ; Salvati, Maurizio ; Delfini, Roberto ; Cantore, Giampaolo. / Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery. In: Journal of Neurosurgery. 2008 ; Vol. 108, No. 6. pp. 1200-1210.
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T1 - Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery

AU - Raco, Antonino

AU - Frati, Alessandro

AU - Santoro, Antonio

AU - Vangelista, Tommaso

AU - Salvati, Maurizio

AU - Delfini, Roberto

AU - Cantore, Giampaolo

PY - 2008/6

Y1 - 2008/6

N2 - Object. Because of the anatomical complexity of the paraclinoid region, the surgical treatment of aneurysms arising in the C6 segment of the internal carotid artery is extremely challenging. The authors' aim in this study was to describe the extended clinical follow-up and assess the short-term and long-term effectiveness of surgical treatment for these aneurysms, focusing on the clinical outcome and degree of aneurysm occlusion and recurrence. Methods. The authors retrospectively analyzed the clinical records for patients treated surgically between 1973 and 2004 at the University of Rome, "La Sapienza." Aneurysms were classified into the following 3 groups according to the site where they arose: the anteromedial, anterior or anterolateral, and posteromedial wall of the C6 segment. Results. Of the 108 aneurysms in 104 patients treated, 63 (58%) were large or giant. Eighty-eight aneurysms in 84 patients were clipped, 16 underwent a high-flow bypass, 2 were trapped, 1 was wrapped, and 1 was left untreated. The mean follow-up was 126 months; 47 patients had a follow-up of > 10 years. Of the 88 aneurysms that were clipped, 6 (6.8%) had an incomplete occlusion that required an immediate reoperation in 1 case and at 2 years in another. Overall 6 patients (5.8%) had surgery-related permanent complications. Conclusions. Mortality and morbidity rates depend mainly on the patient's preoperative Hunt and Hess grade subarachnoid hemorrhage, whereas surgical morbidity principally reflects excessive manipulation of the optic nerve or ischemic problems due to excessive temporary trapping undertaken without adequate neuroprotection. In expert hands, surgery (clipping and bypass procedures) is a definitive treatment for C 6 aneurysms and has an acceptable complication rate.

AB - Object. Because of the anatomical complexity of the paraclinoid region, the surgical treatment of aneurysms arising in the C6 segment of the internal carotid artery is extremely challenging. The authors' aim in this study was to describe the extended clinical follow-up and assess the short-term and long-term effectiveness of surgical treatment for these aneurysms, focusing on the clinical outcome and degree of aneurysm occlusion and recurrence. Methods. The authors retrospectively analyzed the clinical records for patients treated surgically between 1973 and 2004 at the University of Rome, "La Sapienza." Aneurysms were classified into the following 3 groups according to the site where they arose: the anteromedial, anterior or anterolateral, and posteromedial wall of the C6 segment. Results. Of the 108 aneurysms in 104 patients treated, 63 (58%) were large or giant. Eighty-eight aneurysms in 84 patients were clipped, 16 underwent a high-flow bypass, 2 were trapped, 1 was wrapped, and 1 was left untreated. The mean follow-up was 126 months; 47 patients had a follow-up of > 10 years. Of the 88 aneurysms that were clipped, 6 (6.8%) had an incomplete occlusion that required an immediate reoperation in 1 case and at 2 years in another. Overall 6 patients (5.8%) had surgery-related permanent complications. Conclusions. Mortality and morbidity rates depend mainly on the patient's preoperative Hunt and Hess grade subarachnoid hemorrhage, whereas surgical morbidity principally reflects excessive manipulation of the optic nerve or ischemic problems due to excessive temporary trapping undertaken without adequate neuroprotection. In expert hands, surgery (clipping and bypass procedures) is a definitive treatment for C 6 aneurysms and has an acceptable complication rate.

KW - Aneurysm

KW - Carotid artery

KW - Long-term follow-up

KW - Ophthalmic segment

KW - Surgical treatment

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