Background: The management of complex paraclinoid aneurysms is still challenging. In this article we describe our approach to paraclinoid aneurysms, which has evolved over several years, using an exclusively intradural approach.
Method: All procedures are done under continuous electrophysiological monitoring. A standard pterional approach is used to access the paraclinoid region exclusively intraduraly. After optic nerve unroofing and tailored clinoidectomy, the aneurysm neck is visualized and clipped using the tandem clipping technique and suction decompression if necessary. Aneurysm occlusion is verified using intraoperative ICG angiography and postoperative 3D DSA.
Conclusion: The exclusively intradural approach to complex paraclinoid aneurysms with tailored clinoidectomy offers an excellent surgical corridor for the treatment of these challenging lesions.