Microsurgical Techniques for Paraclinoid Aneurysms: A Single-Center Series

Microsurgery for paraclinoid aneurysms remains the first line of treatment in resource-constrained settings. The authors describe their institutional experience and evaluate functional outcomes after microsurgical treatment of paraclinoid aneurysms.

A retrospective review of clinical records was conducted. Multivariable logistic regression assessed predictors of good functional outcomes (modified Rankin Scale score ≤ 2) at last follow-up.

Fifty-six patients (80.4% female; mean age: 55.55 ± 11.27 years) with 58 paraclinoid aneurysms were analyzed. Most paraclinoid aneurysms were located in the ophthalmic segment (53.5%), presented in a ruptured state (56.9%), measured 10-25 mm (65.5%), and had a wide neck (median: 5.2 mm [interquartile range: 4.3-5.78]). The median time from symptom onset to intervention was five days (interquartile range: 3-10). About 51.8% of patients presented with visual deficits. Aneurysm repair involved clipping (87.5%) and clipping with bypass surgery (12.5%). Most cases were performed under a minipterional craniotomy (51.8%) with extradural anterior clinoidectomy (71.4%), carotid control (92.9%), fluorescence angiography (91.1%), and intraoperative Doppler (89.3%). The intraoperative aneurysm rupture rate was 7.1%. An increasing Hunt and Hess score at presentation was associated with lower odds of good functional outcomes (odds ratio: 0.25, 95% confidence interval 0.03-0.745; P = 0.038). At the 6-month follow-up, 91.1% of patients had good outcomes and 72.4% had improved visual outcomes.

The present series showcases the valuable role of microsurgical treatment for patients with paraclinoid aneurysms. Despite the challenges posed by the poor grade of subarachnoid hemorrhage and delayed intervention, microsurgical techniques remain essential to optimizing functional outcomes and minimizing surgical morbidity.