Balloon-assisted microvascular clipping of paraclinoid aneurysms. Technical note

Area of Science:

• Neurosurgery
• Endovascular Surgery
• Cerebrovascular Disease

Background:

• Paraclinoid aneurysms pose significant surgical challenges due to their location.
• Existing techniques aim to safely exclude these aneurysms from circulation.
• Endovascular balloons offer potential for proximal control during aneurysm treatment.

Purpose of the Study:

• To describe and evaluate the technique of using endovascular balloons for proximal control during microsurgical clipping of paraclinoid aneurysms.
• To assess the safety and effectiveness of this adjunctive endovascular approach.

Main Methods:

• Retrospective analysis of six patients with giant or complex paraclinoid/ophthalmic internal carotid artery aneurysms.
• Microsurgical clipping was performed, with attempts to navigate a compliant silicone balloon across the aneurysm neck for proximal control.
• Balloon inflation was utilized during clip placement in successfully navigated cases.

Main Results:

• Successful balloon navigation and inflation across the aneurysm neck was achieved in four out of six patients.
• Postoperative angiography confirmed complete exclusion of all aneurysms from the parent vessel.
• No complications were directly attributed to the endovascular balloon component of the procedure.

Conclusions:

• Endovascular balloon assistance during microsurgical clipping of complex paraclinoid aneurysms is a feasible adjunctive therapy.
• This technique can facilitate safer and more accurate clip placement.
• Further investigation may establish its role in managing challenging cerebral aneurysms.