Ｐａｒａｃｌｉｎｏｉｄ ａｎｅｕｒｙｓｍの治療戦略

Abstract

To establish the optimal therapeutic strategy for paraclinoid aneurysms, we retrospectively analyzed our clinical experiences in 51 patients with 54 paraclinoid aneurysms who had been admitted to our institute since April 1994. The aneurysms were classified as Ia (7), Ib (7), II (17), III (21) and IV (2), according to Al-Rodhan et al., and the sizes of aneurysms (mm) were 3-5 in 27, 6-10 in 15, 11-15 in 3, 16-20 in 6 and >21 in 3 cases. Eight cases showed progressive aggravation of visual symptoms, and 3 cases suffered from SAH. Thin-slice CT provided useful anatomical information of the skull base bony structure and subarachnoid space. Open surgery (OS) (clipping 23, coating 2) resulted in complete anatomical cure in 22 cases (88%), and endovascular surgery (ES) (endosaccular occlusion, 23; IC occlusion, 3) resulted in complete anatomical cure in 18 cases (69%). Aneurysms in Groups Ia and II obtained relatively lower anatomical cure in ES when compared with other groups and OS. Treatment-related complications occurred in 2 large cases (aggravation of visual acuity, basal ggl infarction) of OS and in 3 cases (2 premature rupture, 1 borderzone infarction) of ES. OS is recommended for Groups I and II considering anatomical curability. In Group III, OS is recommended for large symptomatic cases and ES for small ruptured cases to prevent symptomatic aggravation. Small asymptomatic cases in Group III should be treated considering treatment-related risks. Observation is recommended in cases of Group IV if they are asymptomatic.