Surgical clipping for large and giant unruptured paraclinoid aneurysms in hybrid operation theater

Abstract

Objective To evaluate the clinical value and outcomes of surgical clipping for large and giant unruptured paraclinoid aneurysms. Methods A retrospective analysis was conducted on 8 patients (11 aneurysms) who underwent aneurysm clipping assisted with balloon occlusion in hybrid operation theatre at Neurosurgery Department of Xuanwu Hospital, Capital Medical University, from January 2014 to March 2017. All patients were females whose average age was 54.9±5.7 years. Results Among 11 aneurysms in this series, a total of 9 aneurysms were treated and included 8 large or giant paraclinoid aneurysms and 1 carotid cave aneurysm. Intraoperative radiography demonstrated that all 9 aneurysms were successfully obliterated, 1 patient developed occlusion of parent artery and 1 had severe stenosis of parent artery. Three patients encountered ischemic events postoperatively. The assessment at discharge indicated a Glasgow Outcome Score (GOS) of 5 in 5 patients, 4 in 1 case and 3 in 2 cases. At the follow-up which was conducted 1.5-39.5 [average: 10.7 (P25: 3.2, P75: 32.3)] months post operation, a GOS of 5 was reported 7 patients and 4 in 1 case. Vision acuity was improved in 7 patients and remained stable in 1 case. Conclusion Hybrid surgery seems to be able to facilitate clipping of large and giant unruptured paraclinoid aneurysms, but more studies are needed for exploration of proper interventional devices and methods. Key words: Intracranial aneurysm; Carotid artery, internal; Paraclinoid; Hybrid operation; Balloon occlusion; Surgical clipping