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Paraclinoid Aneurysms: Who to Treat with Craniotomy?

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Controversies in Vascular Neurosurgery

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Abstract

Even with the advent of the latest endovascular techniques such as flow diverter stents, paraclinoid aneurysms remain a formidable challenge for vascular neurosurgeons. Obliteration of the large/giant paraclinoid aneurysms with endovascular treatment has a lower success rate for total occlusion. Patients with paraclinoid aneurysms with other distal aneurysms not well suited for endovascular treatment or with hematoma from ruptured paraclinoid aneurysms needing evacuation may best be managed with microsurgery. Ruptured paraclinoid aneurysms with complex morphology, not suitable for stand-alone coiling, are often better managed with microsurgery. The use of a stent or flow-diverting stents in such patients necessitates the use of antiplatelet medications, such as aspirin and clopidogrel, which may be undesirable in the setting of subarachnoid hemorrhage due to the frequent need for surgical procedures. The patients presenting with progressive visual symptoms from mass effect due to the aneurysm are also better managed with microsurgery. Relative contraindications for endovascular treatment for which microsurgery remains a viable option include resistance to the antiplatelet medications, difficult anatomy to assess through endovascular option, and patient’s preference for microsurgery. Thence, microsurgery still has a significant role in the management of paraclinoid aneurysms for certain indications.

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Authors and Affiliations

  1. Department of Neurosurgery, Covenant Medical Center, Waterloo, IA, USA

    Amit Singla MD

  2. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA

    Kyle M. Fargen MD, MPH

  3. Department of Neurological Surgery, Cerebrovascular Center, Mount Sinai Health System, New York, NY, USA

    J. Mocco MD, MS

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  1. Amit Singla MD
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  2. Kyle M. Fargen MD, MPH
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  3. J. Mocco MD, MS
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Correspondence to J. Mocco MD, MS .

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Editors and Affiliations

  1. Neuroscience Inst. Dept. of Neurosurgery, Drexel Univ. College of Medicine, Drexel, Philadelphia, Pennsylvania, USA

    Erol Veznedaroglu

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Singla, A., Fargen, K.M., Mocco, J. (2016). Paraclinoid Aneurysms: Who to Treat with Craniotomy?. In: Veznedaroglu, E. (eds) Controversies in Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27315-0_1

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