Surgical management of paraclinoid aneurysms

Paraclinoid aneurysms arise from C5 clinoid segment and C6 ophthalmic segment, within the internal carotid artery. Brain aneurysms have a frequency ranging from 5 to 11 %. A successful surgery requires knowledge of the anatomic region and the aneurysm. The objective was to show the surgical management of paraclinoid aneurysms. From January 2009 to January 2015, we carried out a retrospective study in the Neurosurgery Department at Centro Médico Nacional Siglo XXI. We included 66 patients with the diagnosis of paraclinoid aneurysm. We obtained the clinical characteristics, evolution, complications, and outcomes from the clinical and radiological records. 61 patients (92.4 %) were female; 65 underwent neurosurgical clipping, and one underwent cerebral bypass surgery with exclusion of the aneurysm. Forty six patients presented subarachnoid hemorrhage due to aneurysmal rupture. By reason of their location, 35 paraclinoid aneurysms (53 %) were superior, 20 medial (30.3 %) and 4 inferior (6 %). Thirty three patients had small aneurysms, 23 large aneurysms, and 10 patients presented giant aneurysms. After surgery, 51 patients had good results, since they scored 4 and 5 in the Glasgow Outcome Score. Three patients presented amaurosis as a surgery-related complication. Microsurgical management is still the best treatment for these aneurysms, due to its ability to exclude them entirely; besides, is the best method to decompress the optic nerve.