Microneurosurgery for Paraclinoid Aneurysms in the Context of Flow Diverters

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The advent of flow diverter (FD) stents has apparently reduced the role of microneurosurgery for paraclinoid aneurysms despite sparse high-quality evidence about their long-term effects. The present study critically reviews the overall results of a microneurosurgical series of 57 paraclinoid aneurysms. Of these aneurysms, 47.4% were regular in size while 19.3 were giant. Barami type I was predominant. In 21 aneurysms a hemorrhagic onset occurred. Pterional approach with intradural anterior clinoidectomy was preferred by far. Clipping was possible in 91.2% of aneurysms and a high-flow bypass was the choice in five cases. An mRS of 0–2 was achieved in 77.3% of patients, typically <50 years old. Visual field appeared improved or unchanged in 36.3% and 63.6% of the symptomatic patients, respectively. In 76.1% of incidental aneurysms, campimetry was unaffected by surgery. A complete aneurysm exclusion was achieved in 93% of cases using a single procedure. No recurrences were documented on an average follow-up of 54.1 ± 34 months. Microneurosurgery is still a valuable, definitive, and durable option for Barami type Ia, Ib, or II paraclinoid aneurysm, especially in patients <50 years old and visually symptomatic. Conditions other than these are ideal candidates for FD stents.

Original languageEnglish
Title of host publicationActa Neurochirurgica, Supplementum
PublisherSpringer Science and Business Media Deutschland GmbH
Pages47-53
Number of pages7
DOIs
Publication statusPublished - 2021

Publication series

NameActa Neurochirurgica, Supplementum
Volume132
ISSN (Print)0065-1419
ISSN (Electronic)2197-8395

Keywords

  • Anterior clinoidectomy
  • Brain Aneurysms
  • Clipping
  • Internal Carotid artery
  • Ophthalmic aneurysms
  • Paraclinoid aneurysms
  • Pterional approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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