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Unruptured paraclinoid aneurysms: a management strategy.
Koji Iihara1, Kenichi Murao, Nobuyuki Sakai
1Department of Cerebrovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. kiihara@hsp.ncvc.go.jp
Journal of Neurosurgery
|August 20, 2003
Summary
Direct surgery is recommended for superiorly projecting paraclinoid aneurysms due to higher obliteration rates. Endovascular treatment is suitable for other groups, particularly carotid cave aneurysms.
Area of Science:
- Neurosurgery
- Endovascular Therapy
- Cerebrovascular Diseases
Background:
- Unruptured paraclinoid aneurysms require optimal management strategies.
- Direct surgery and endovascular treatments are primary therapeutic options.
Observation:
- A retrospective review of 112 procedures for 111 unruptured paraclinoid aneurysms (1997-2002).
- Aneurysms were classified using a modified al-Rodhan system (Groups Ia, Ib, II, III, IV).
- Treatments included direct surgery (35 lesions) and endovascular methods (77 lesions).
Findings:
- Endovascular therapy for superiorly projecting aneurysms (Groups Ia, II) showed lower obliteration rates than surgery.
- Cerebral embolic events were comparable between endovascular treatments across groups.
- Endovascular treatment for Group II aneurysms carried risks of retinal embolism; direct surgery achieved 80% obliteration for Group Ia/Ib and 71.4% for Group II.
- Surgery had lower transient (8.6%) and permanent (2.9%) morbidity rates compared to endovascular treatment (14.3% transient, 6.5% permanent).
Implications:
- Direct surgery is preferred for superiorly projecting paraclinoid aneurysms (Groups Ia, II).
- Endovascular treatment is a viable first-line option for other aneurysm types, especially Group III (carotid cave).
- Treatment decisions should consider aneurysm location, projection, and associated risks.