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Japanese

Microsurgical Results of Paraclinoid Aneurysms of the Internal Carotid Artery : microsurgery versus intravascular surgery Shiro NAGASAWA 1 , Shinji KAWABATA 1 , Jun DEGUCHI 1 , Terumasa KUROIWA 1 , Tomio OHTA 1 , Eimei TSUDA 2 1Department of Neurosurgery, Osaka Medical College 2Department of Neurosurgery, Soseikai General Hospital Keyword: dural ring , intravascular surgery , ophthalmic artery , paraclinoid aneurysm , microsurgery pp.809-816
Published Date 1999/9/10
DOI https://doi.org/10.11477/mf.1436901773
  • Abstract
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Since paraclinoid aneurysms exhibit considerable variations in the surrounding skull base structures,some skill and experience are considered essential for their microsurgical treatment. On the other hand, in-travascular coil embolization would be free from these extravascular factors.

Fifty-two aneurysms in 48 patients were treated microsurgically. They were divided into an early seriestreated before 1995 and a late series treated after 1996. Three aneurysms in 3 patients were treated by in-travascular surgery. Preoperative neuroimages, topographic anatomy and surgical results were comparedretrospectively.

The results in the microsurgical late series were better than those in the early series. While 89% of thepatients exhibited excellent results with two patients left with partial visual field defect (7%) and one death(3%) in the early series, the rates in the late series were 95%, 5% and 0%, respectively. Complications andfailure in neck clipping were considered to be due to such topography as, 1) C3 aneurysms extending intothe anterior clinoid process, 2) multiple aneurysms, 3) ophthalmic artery originating near the dome, 4)atheroma or calcification at the neck, 5) marked medial shift of C2 segment, and 6) tight adhesion of thedural ring to the dome. Coil embolization was successful in two aneurysms, while it was given up in one. We currently propose that intravascular surgery is indicated for cases 1), 4), 5) and 6), and micro-surgery would be more advantageous for cases where the neck is broad and where the topography con-cerning aneurysmal multiplicity or the branching site of the ophthalmic artery is not fully understood bypreoperative imaging.


Copyright © 1999, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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