Anterior clinoidectomy for the management of paraclinoid aneurysms

Abstract

Objective To investigate the surgical skills and clinical efficacy of anterior clinoidectomy for the management of paraclinoid aneurysms. Methods The clinical data of 25 patients with paraclinoid aneurysm treated with anterior clinoidectomy from January 2010 to July 2014 were analyzed retrospectively. Of the 25 patients, 19 were females and 6 were males (mean age 51.4 years). Six patients had multiple intracranial aneurysms, 8 had ruptured aneurysms, and 17 had unruptured aneurysms. The size of paraclinoid aneurysms: 6 were less than 5 mm, 13 were 5 mm to 15 mm, and 6 were more than 15 mm. All the patients performed the removal of the anterior clinoid process in subdural space via pterional approach, 9 aneurysms were clipped directly, and 16 were clipped and shaped. Postoperative digital subtraction angiography (DSA) was performed and the Glasgow outcome scale (GOS) was used to evaluate the efficacy during the follow-up period. Results Postoperative DSA indicated that 2 patients had residual aneurysm necks, and 2 had parent artery stenosis. All patients were followed up for 1 to 51 months (mean 22.5 months). Ten patients had good prognosis (GOS 5), 13 had mild disability (GOS 4), and 2 had severe disability (GOS 3). Conclusion The removal of the anterior clinoid process, opening the superior wall of optic canal, and isolating the internal carotid artery of clinoid segment may provide better a surgical field for exposing and clipping aneurysms, and thus improve the safety and efficacy of surgical treatment of paraclinoid aneurysms. Key words: Intracranial aneurysm; Microsurgery; Ophihalmic artery