Clinical Outcome of paraclinoid aneurysms after Microsurgical neck clipping in Comparison with Endovascular Embolization

Abstract

Objective : Because of the complex anatomical association among vascular,dural, and bony structures, paraclinoid internal carotid artery (ICA)aneurysms remain a major challenge for vascular neurosurgeons. Westudied the clinical outcomes of 61 paraclinoid ICA aneurysms after microsurgicalclipping in comparison with endovascular coiling. Materials and Methods : Between January 2008 and December 2012, wetreated 61 paraclinoid ICA aneurysms created by surgical clipping or endovascularcoiling. Preoperative neurologic status and postoperative outcomewere evaluated using the Glasgow coma scale (GCS) and themodified Rankin scale (mRS). Postoperative hydrocephalus and vasospasmwere reviewed using the patients' medical charts. Results : Most patients were in good clinical condition before the operationsand had good treatment outcomes. Clinical vasospasm was observedafter the operation in five patients, and hydrocephalus occurred insix patients. No statistically significant difference regarding aneurysm size,sex, GCS score, H-H grade, and mRS was observed between the surgicalclipping group and the endovascular coiling group. In addition, the treatmentresults and complications did not show statistically significant differencein either group. Conclusion : Surgical occlusion of paraclinoid ICA aneurysms is difficult;however, no significant differences were observed in the treatment resultsor complications when compared with coil embolization. In particular, useof an adequate surgical technique may lead to better outcomes thanthose for coil embolization in the treatment of large and/or wide-neckparaclinoid ICA aneurysms.