Introduction: The anatomic complexity of the paraclinoid region presents unique technical challenges while performing microsurgical clipping of paraclinoid aneurysms. This study aimed to analyze microsurgical clipping techniques, complications, and outcomes associated with paraclinoid aneurysms, with a focus on the nuances of clip selection and clipping technique according to aneurysm location.
Methods: The patient records of 216 patients with 231 unruptured paraclinoid aneurysms, presenting between 1997 to 2016 and treated using microsurgical clipping were retrospectively reviewed. The features of clip selection and clipping techniques, in relation to aneurysm location were recorded and clinical outcomes were analyzed.
Results: In this dataset, simple clipping was performed for 34.6% of the aneurysms. Amongst these, a preference for the use of fenestrated clips was observed with superior hypophyseal artery (SHA) aneurysms, while curved clips were used for most other aneurysms. 65.6% of aneurysms were managed with the use of multiple clips. These included the use of tandem clipping for ophthalmic artery (OphA) aneurysms, tandem angled fenestrated clipping for SHA and ventral carotid aneurysms, stacked clipping for dorsal carotid aneurysms, and various techniques for clinoidal segment/carotid cave aneurysms. In 91.1% of patients, complete obliteration of the aneurysms was confirmed on post-operative angiography. The overall functional outcome was good (mRS 0-2) for 99.6% of patients, although new postoperative visual deficits were observed in 13.0% of the cases
Conclusions: Surgical clipping is an indispensable treatment option for paraclinoid aneurysms. It is associated with good clinical outcomes and acceptable complication rates. Careful and appropriate selection of the clips and clipping techniques is important in order to achieve complete and safe aneurysm obliteration.
Patient Care: By highlighting the nuances of clipping techniques and clip selection based on the location of the aneurysm, this results of this study will enable neurosurgeons to tailor their management strategy accordingly, leading to better clinical outcomes
Learning Objectives: 1. To identify the different clipping techniques available for the microsurgical management of paraclinoid internal carotid artery aneurysms
2. To understand the importance of appropriate selection of the clips and clipping technique based on the location of the aneurysm