Large paraclinoid aneurysm with a calcified neck treated by tailored multimodality procedures

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Paraclinoid aneurysms present unique anatomical challenges for treatment.
• Severe neck calcification and collateral flow can complicate standard surgical and endovascular approaches.
• Visual symptoms indicate the need for timely and effective intervention.

Observation:

• A 68-year-old woman presented with a large paraclinoid aneurysm causing visual disturbances.
• The aneurysm had a severely calcified neck, making direct clipping hazardous.
• Endovascular trapping was difficult due to the aneurysm's proximity to the posterior communicating artery origin.
• Significant collateral backflow via the ophthalmic artery (OphA) limited the efficacy of proximal occlusion.

Findings:

• A successful treatment strategy involved a high-flow bypass.
• Intraoperative coil embolization of the parent artery, including the OphA origin, was performed.
• Distal clipping of the internal carotid artery was also utilized.
• This combined multimodality approach effectively treated the complex paraclinoid aneurysm.

Implications:

• Standard treatment modalities like direct clipping or endovascular coiling may be insufficient for complex paraclinoid aneurysms.
• Multimodality treatment strategies can be tailored to overcome specific anatomical and pathological challenges.
• Successful management of such complex aneurysms can prevent neurological deficits and improve patient outcomes.