Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms

Se-Yang Oh; Kwan Sung Lee; Bum-Soo Kim; Yong Sam Shin

doi:10.1016/j.clineuro.2014.11.008

Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms

Clin Neurol Neurosurg. 2015 Jan:128:72-7. doi: 10.1016/j.clineuro.2014.11.008. Epub 2014 Nov 15.

Authors

Se-Yang Oh¹, Kwan Sung Lee², Bum-Soo Kim³, Yong Sam Shin⁴

Affiliations

¹ Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, Republic of Korea.
² Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
³ Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
⁴ Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea. Electronic address: nsshin@gmail.com.

PMID: 25462100
DOI: 10.1016/j.clineuro.2014.11.008

Abstract

Objective: Advances in endovascular treatment (EVT) have greatly improved the treatment outcomes of paraclinoid aneurysms. However, EVT had the shortcoming of durability and thromboembolic complications. As well, surgical treatment of paraclinoid aneurysms is still challenging due to the complexity of adjacent structures. The objective of this study is to report our experience with a combined surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms.

Methods: A retrospective review was conducted of 185 cases of unruptured paraclinoid aneurysms that underwent surgical or endovascular treatment between September 2008 and August 2012. Thirty-one aneurysms (16.8%) were treated by microsurgery and 154 (83.2%) were treated by EVT. Fifty aneurysms (27.0%) were classified to the dorsal group and 135 (73%) were classified to the non-dorsal group.

Results: Twenty of 50 dorsal group aneurysms (40%) were treated by microsurgery while 124 of 135 non-dorsal group aneurysms (91.9%) underwent an EVT. The rate of complete occlusion was 96.8% in surgical series and 60.4% in EVT (P < 0.001). Recanalization occurred in 9 aneurysms (5.8%) of EVT and 1 aneurysm (3.2%) of surgical series (P = 0.360). In non-dorsal group, transient complications (10 aneurysms (5.4%), P = 0.018) and morbidity at last visiting (6 aneurysms (3.2%), P = 0.021) were more present in surgically treated cases rather than in EVT cases. Diplopia and visual field defect occurred in the non-dorsal group only; in 2 of 11 surgical cases (18.2%) and in 1 of 124 EVT series (0.8%) (P = 0.017). The overall rate of excellent or good clinical outcomes (Glasgow outcome scale 5 or 4) was 98.9%.

Conclusion: EVT is a safe and effective treatment for the non-dorsal group. Based on angiographic and clinical aspects, microsurgical clipping has prior efficacy with better outcomes in the dorsal group under proper individualized selection.

Keywords: Endovascular treatment; Microsurgical treatment; Paraclinoid aneurysm.

MeSH terms

Adult
Aged
Aged, 80 and over
Carotid Artery Diseases / pathology
Carotid Artery Diseases / surgery
Carotid Artery Diseases / therapy*
Endovascular Procedures / methods*
Female
Humans
Intracranial Aneurysm / pathology
Intracranial Aneurysm / surgery
Intracranial Aneurysm / therapy*
Male
Microsurgery / methods*
Middle Aged
Retrospective Studies
Treatment Outcome