Unruptured paraclinoid aneurysms: a management strategy

• DOI: 10.3171/jns.2003.99.2.0241
• Publication Date: 2009-05-13T17:53:44Z
• Authors: Koji Iihara; Kenichi Murao; Nobuyuki Sakai; Atsushi Shindo; Hideki Sakai; Toshio Higashi; Shuji Kogure; Jun C. Takahashi; Katsuhiko Hayashi; Toshihiro Ishibashi; Izumi Nagata
• Keywords: Adult; Male; Vision Disorders; Intracranial Aneurysm; Middle Aged; Embolization, Therapeutic; Severity of Illness Index; Neurosurgical Procedures; Ophthalmic Artery; 03 medical and health sciences; Carotid Arteries; 0302 clinical medicine; Humans; Female; Follow-Up Studies

Object. To elucidate an optimal management strategy for unruptured paraclinoid aneurysms, the authors retrospectively reviewed their experience in treatment of 100 patients who underwent 112 procedures 111 aneurysms performed using direct surgery and/or endovascular treatment. Methods. Between 1997 and 2002, categorized according to a modified al-Rodhan classification (Group Ia, 30 anterior wall lesions; Group Ib, 25 ventral II, 18 true ophthalmic artery III, 37 carotid cave IV, one transitional lesion) were treated by (35 lesions) (77 (one aneurysm was both procedures). In lesions Groups III that treatment, complete obliteration achieved 50, 65, 78%, respectively, combined transient permanent morbidity rates due cerebral embolic events 20, 25, 13.9%, respectively. Overall, rate after 14.3% 6.5%. Notably, visual deficits caused retinal embolism occurred two with II aneurysms. Direct mainly Ia (20 lesions), Ib (five (eight neck clip occlusion 80, 71.4%, respectively; associated 8.6 2.9%, Conclusions. Endovascular therapy superiorly projecting (Groups II) is lower than surgery, comparable those other groups. Furthermore, entails additional risks embolism. Therefore, recommended superiorly. For groups, especially acceptable first line therapy.