Clinical Analysis of Ruptured Lateral Paraclinoid Carotid Aneurysm

We report two cases of ruptured lateral paraclinoid carotid aneurysms. Case 1 : A 41-year-old man presented with a sudden headache. A CT scan showed a subarachnoid hemorrhage. Cerebral angiography revealed a large paraclinoid carotid aneurysm projecting posterolaterally. Proximal artery control was accomplished through a balloon catheter prior to craniotomy. The aneurysmal neck was not broad, so the clip was placed perpendicularly to the carotid artery. Case 2 : A 71-year-old woman presented suffering from a headache and simultaneous double vision. A CT scan showed no apparent subarachnoid hemorrhage. Cerebral angiography revealed a large paraclinoid carotid aneurysm posterolaterally. Proximal artery control was accomplished by exposure of the cervical internal carotid artery prior to craniotomy. Intraoperative findings revealed a subarachnoid hemorrhage in the basal cistern. The aneurysmal neck was broad, so the clip was placed parallel to the carotid artery so as not to involve the posterior communicating artery. Paraclinoid carotid aneurysms of the ophthalmic segment are usually classified into three categories, but in the case of lateral projection, it is hard to definitively classify. This report describes such surgical experiences clipping ruptured lateral paraclinoid carotid aneurysms.