Abstract
Paraclinoid aneurysms arise from the internal carotid artery (ICA), beyond the venous lumen of the cavernous sinus and proximal to the origin of the posterior communicating artery (PcomA), a territory known as the clinoidal and ophthalmic segments of the ICA. Paraclinoid aneurysms are intradural, and their rupture is thus associated with a risk of subarachnoid hemorrhage (SAH). Complex relationships between the vascular, neural, dural, and osseous structures in this area make surgery of this group of aneurysms challenging. However, these relationships usually do not affect endovascular therapy with flow diverter stents, making this strategy a good alternative for surgery in patients with paraclinoid aneurysms.
A 33-year-old woman presented with a history of chronic headaches since childhood and complained of recent onset of unspecific visual disturbances. Four years earlier, she had undergone a first-ever neuroradiological evaluation resulting in the discovery of a mid-cervical right ICA dissection and a left paraclinoid ICA aneurysm. The patient was managed conservatively. Admission MRI/MRA was compared with previous MR studies that confirmed the aneurysm had shown subtle changes in shape, and MRI vessel wall imaging (VWI) showed contrast enhancement of the aneurysm wall. During the current admission, the patient underwent endovascular treatment of the aneurysm by flow diverter stent implantation (Pipeline Flex Embolization Device with Shield Technology) in an uneventful procedure. Follow-up studies confirmed the angiographic exclusion of the aneurysm.
Paraclinoid aneurysm nosology, the role of MR VWI in evaluating unruptured intracranial aneurysms, and the changing management paradigm toward endovascular flow diversion techniques are the main topics of this chapter.
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Filioglo, A., Leker, R.R., Honig, A., Cohen, J.E. (2021). Paraclinoid Internal Carotid Artery Aneurysm: Unruptured Lateral Paraclinoid Aneurysm Showing Aneurysm Wall Enhancement on MRI Vessel Wall Imaging, Treated with Flow Diversion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_187-1
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