Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review

Microneurosurgery for Paraclinoid Aneurysms in the Context of Flow Diverters

Sabino Luzzi  1   2 , Mattia Del Maestro  2   3 , Renato Galzio  1   2
Giuseppe Esposito  1 , Luca Regli  1 , Marco Cenzato  2 , Yasuhiko Kaku  3 , Michihiro Tanaka  4 , Tetsuya Tsukahara  5
, editors.
In: Trends in Cerebrovascular Surgery and Interventions [Internet]. Cham (CH): Springer; 2021.
.
Affiliations
Free Books & Documents
Review

Microneurosurgery for Paraclinoid Aneurysms in the Context of Flow Diverters

Sabino Luzzi et al.
Free Books & Documents

Excerpt

The advent of flow diverter (FD) stents has apparently reduced the role of microneurosurgery for paraclinoid aneurysms despite sparse high-quality evidence about their long-term effects.

The present study critically reviews the overall results of a microneurosurgical series of 57 paraclinoid aneurysms.

Of these aneurysms, 47.4% were regular in size while 19.3 were giant. Barami type I was predominant. In 21 aneurysms a hemorrhagic onset occurred. Pterional approach with intradural anterior clinoidectomy was preferred by far. Clipping was possible in 91.2% of aneurysms and a high-flow bypass was the choice in five cases. An mRS of 0–2 was achieved in 77.3% of patients, typically <50 years old.

Visual field appeared improved or unchanged in 36.3% and 63.6% of the symptomatic patients, respectively. In 76.1% of incidental aneurysms, campimetry was unaffected by surgery.

A complete aneurysm exclusion was achieved in 93% of cases using a single procedure. No recurrences were documented on an average follow-up of 54.1 ± 34 months.

Microneurosurgery is still a valuable, definitive, and durable option for Barami type Ia, Ib, or II paraclinoid aneurysm, especially in patients <50 years old and visually symptomatic. Conditions other than these are ideal candidates for FD stents.

PubMed Disclaimer

References

    1. Barami K, Hernandez VS, Diaz FG, Guthikonda M (2003) Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme. Skull Base 13:31–41. https://doi.org/10.1055/s-2003-820555 - DOI - PMC - PubMed
    1. Bouthillier A, van Loveren HR, Keller JT (1996) Segments of the internal carotid artery: a new classification. Neurosurgery 38:425–432; discussion 432–3. - PubMed
    1. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607 - PubMed
    1. Luzzi S, Elia A, Del Maestro M, Morotti A, Elbabaa SK, Cavallini A, Galzio R (2019) Indication, timing, and surgical treatment of spontaneous intracerebral hemorrhage: systematic review and proposal of a management algorithm. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.01.016 - DOI - PubMed
    1. Batjer HH, Samson DS (1990) Retrograde suction decompression of giant paraclinoidal aneurysms. Technical note. J Neurosurg 73:305–306. https://doi.org/10.3171/jns.1990.73.2.0305 - DOI - PubMed

LinkOut - more resources