Endovascular-assisted microsurgical clipping of ophthalmic segment aneurysms

Proximal arterial control is critical for safe and effective microsurgical clipping of ophthalmic segment aneurysms (OSAs). Traditionally, this is achieved via neck dissection and temporary clamping of the cervical internal carotid artery (ICA). Advances in endovascular technology have introduced temporary balloon occlusion (TBO) as a potentially less invasive alternative. This study aims to assess the utility of TBO during microsurgical clipping of OSAs.

A retrospective review was conducted of all patients at a single institution who underwent microsurgical OSA clipping with planned TBO. Patient demographics, presentation, aneurysm morphology, occlusion outcomes, complications, recurrence, and functional outcomes based on modified Rankin score (mRS) at follow-up were evaluated. Patients who underwent balloon inflation for proximal control (+ TBO) were compared with those who did not (-TBO).

A total of 34 patients with 35 OSAs were included. A temporary balloon guide catheter was successfully navigated to the cervical carotid in all cases. TBO was performed in 19 patients (20 aneurysms) during aneurysm clipping. Aneurysm sizes ranged from 2.8 to 18.0 mm (mean: 6.7 mm), with neck sizes ranging from 1.6 to 8.1 mm (mean: 4.2 mm). The + TBO group had a significantly higher proportion of wide-necked aneurysms (> 4 mm) compared to the -TBO group (55.0% vs. 26.7%; p = 0.008) and more frequently required anterior clinoidectomy (84.2% vs. 46.7%; p = 0.020). Complete or near-complete (< 2 mm remnant) aneurysm occlusion was achieved in all cases. There was one complication (2.9%) with permanent sequela and median mRS at follow-up was 0. There were no significant differences in complication rates or functional outcomes between the + TBO and -TBO groups.

Endovascular-assisted TBO is a safe and effective minimally invasive alternative to open neck dissection for achieving proximal control during OSA clipping. TBO may be particularly advantageous for managing wide-neck aneurysms.