Summary
Surgical treatment of paraclinoid aneurysms is considered to be difficult due to their complicated anatomical location in the vicinity of important neural, vascular and bony structures. We present our clinical experience of the past 10 years of conventional microsurgical treatment of 81 paraclinoid aneurysms in 75 patients with the use of selective extradural anterior clinoidectomy SEAC and discuss the method of therapy option by reviewing recent reports on results of endovascular coiling method and the combination of these with conventional microsurgical therapy. The favorable surgical results with the use of SEAC and no recurrence of the treated aneurysm after clipping procedure in our series indicate that direct surgery can still be a standard technique for paraclinoid aneurysms in view of the fact that the endovascular aneurysm coiling methods are still associated with a considerable percentage of incomplete occlusion and present the problem of coil packing.
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Arnautovic KI, Al-Mefty O, Angtuaco E (1998) A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol 50: 504–520
Barnett DW, Barrow DL, Joseph GJ (1994) Combined extracranial-intracranial bypass and intraoperative balloon occlusion for the treatment of intracavernous and proximal carotid artery aneurysms. Neurosurgery 35: 92–98
Batjer HH, Kopitnik TA, Giller CA, Samson DS (1994) Surgery for paraclinoidal carotid artery aneurysms. J Neurosurg 80: 650–658
Benedetti A, Curri D (1977) Direct attack on carotid ophthalmic and large internal carotid aneurysms. Surg Neurol 8: 49–54
Brilstra EH, Rinkel GJ, van der Graaf Y, van Rooij WJ, Algra A (1999) Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke 30: 470–476
Day AL (1990) Aneurysm of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72: 677–691
Debrun G, Fox A, Drake C, Peerless S, Girvin J, Ferguson G (1981) Giant unclippable aneurysms: treatment with detachable balloons. AJNR Am J Neuroradiol 2: 167–173
De Jesus O, Sekhar LN, Riedel CJ (1999) Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome. Surg Neurol 51: 477–488
Dolenc VV (1985) A combined epi-and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62: 667–672
Drake CG, Peerless SJ, Ferguson GG (1994) Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 81: 656–665
Dyste GN, Beck DW (1989) De novo aneurysm formation following carotid ligation: case report and review of the literature. Neurosurgery 24: 88–92
Ferguson GG, Drake CG (1981) Carotid-ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment. Surg Neurol 16: 1–8
Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR (1994) Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR (abbreviation of Am J Neuroradiol) 15: 815–820
Fischer E (1938) Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zbl Neurochir 3: 300–313
Fox JL, Vinuela F, Pelz DM, Peerrless SJ, Ferguson GG, Drage CG, Debrun G (1987) Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66: 40–46
Gelber BR, Sundt TM Jr (1980) Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra-to intracranial bypass. J Neurosrug 52: 1–10
Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 75: 8–14
Guidetti B, La Torre E (1979) Carotid-ophthalmic aneurysms. A series of 16 cases treated by direct approach. Acta Neurochir (Wien) 22: 289–304
Gurian JH, Vinuela F, Guglielmi G, Gobin YP, Duckwiler GR (1996) Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 39: 1150–1156
Hacein-Bey L, Connolly ES Jr, Mayer SA, Young WL, Pil-Spellman J, Solomon RA (1998) Complex intracranial aneurysms: combined operative and endovascular approaches (review). Neurosurgery 43: 1304–1313
Hashi K, Nin K (1985) Complications following carotid ligation combined with EC-IC bypass. Neurosurgeons 4: 359–366 [Jpn]
Hashimoto N, Handa H, Hazama F (1978) Experimentally induced cerebral aneurysms in rats. Surg Neurol 10: 3–8
Hayakawa M, Murayama Y, Duckwiler GR, Gobin YP, Guglielmi G, Vinuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93: 561–568
Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G (1983) Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 12: 153–163
Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS (2001) Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 48: 78–90
Hope JK, Byrne JV, Molyneux AJ (1999) Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR (abbreviation of Am J Neuroradiol) 20: 391–399
Hopkins LN, Grand W (1979) Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5: 21–31
Iihara K, Murao K, Sakai N, Shindo A, Sakai H, Higashi T, Kogure S, Takahashi JC, Hayashi K, Ishibashi T, Nagata I (2003) Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg 99: 241–247
Kattner KA, Bailes J, Fukushima T (1998) Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases (review). Surg Neurol 49: 471–480
Kothandaram P, Dawson BH, Kruyt RC (1971) Carotidophthalmic aneurysms. A study of 19 patients. J Neurosurg 34: 544–548
Kumon Y, Sakaki S, Kohno K, Ohue S, Oka Y (1997) Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol 48: 465–472
Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 1: 538–546
Larson JJ, Tew JM Jr, Tomsick TA, van Loveren HR (1995) Treatment of aneurysms of the internal carotid artery by intravascular balloon occlusion: long-term follow-up of 58 patients. Neurosurgery 36: 23–30
Mizoi K, Takahashi A, Yoshimoto T, Fujiwara S, Koshu K (1993) Combined endovascular and neurosurgical approach for paraclinoid internal carotid artery aneurysms. Neurosurgery 33: 986–992
Morgan F (1972) Removal of antertior clinoid process in the surgery of carotid aneurysm, with some notes on recurrent subarachnoid haemorrhage during craniotomy. Schweiz Arch Neurol Neurochir Psychiatr 111: 363–368
Park HK, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K, Purdy P (2003) Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 53: 14–24
Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Esperance G (1997) Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR (abbreviation of Am J Neuroradiol) 18: 1207–1215
Serbinenko FA, Filatov JM, Spallone A, Tchurilov MV, Lazarev VA (1990) Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion. J Neurosurg 73: 57–63
Spetzler RF, Selman W, Carter LP (1984) Elective EC-IC bypass for unclippable intracranial aneurysms. Neurol Res 6: 64–68
Sugita K, Kobayashi S, Kyoshima K, Nakagawa F (1982) Fenestrated clips for unusual aneurysms of the carotid artery. J Neurosurg 57: 240–246
Swearingen B, Heros RC (1987) Common carotid occlusion for unclippable carotid aneurysms: an old but still effective operation. Neurosurgery 21: 288–295
Tamaki N, Kim S, Ehara K, Asada M, Fujita K, Taomoto K, Matsumoto S (1991) Giant carotid-ophthalmic artery aneurysms: direct clipping utilizing the “trapping-evacuation” technique. J Neurosurg 74: 567–572
Thornton J, Aletich VA, Debrun GM, Alazzaz A, Misra M, Charbel F, Ausman JI (2000) Endovascular treatment of paraclinoid aneurysms. Surg Neurol 54: 288–299
Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86: 475–482
Yasargil MG, Gasser JC, Hodosh RM, Rankin TV (1977) Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol 8: 155–165
Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, Roth P, Groscurth P (1997) Selective extradural anterior clinoidectomy for supra-and parasellar processes. Technical note. J Neurosurg 87: 636–642
Yonekawa Y, Khan N, Roth P (2002) Strategies for surgical management of cerebral aneurysms of special location, size and form — approach, technique and monitoring. Acta Neurochir (Wien) [Suppl] 82: 105–118
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Khan, N. et al. (2005). Conventional microsurgical treatment of paraclinoid aneurysms: state of the art with the use of the selective extradural anterior clinoidectomy SEAC. In: Yonekawa, Y., Keller, E., Sakurai, Y., Tsukahara, T. (eds) New Trends of Surgery for Stroke and its Perioperative Management. Acta Neurochirurgica Supplements, vol 94. Springer, Vienna. https://doi.org/10.1007/3-211-27911-3_5
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DOI: https://doi.org/10.1007/3-211-27911-3_5
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