నైరూప్య

Surgical management of paraclinoid aneurysms via frontal lateral approach

Shuo Wang, Zhisheng Kan, Jiantao Wang

Objective: Towards exploring minimally invasive techniques in paraclinoid aneurysms clipping via a frontal lateral approach.

Methods: 118 patients by frontal lateral approach in the last 2.5 y in Beijing Tiantan Hospital were analysed retrospectively. Clinical data and follow-up outcomes of the patients were reviewed. Digital Subtraction Angiography (DSA) was performed among all patients to categorize the paraclinoid aneurysms. The microsurgery through frontal lateral approach was performed in 118 patients. According to various subtypes of paraclinoid aneurysms, summarize and compare the surgical skills and outcome of the treatment.

Outcomes: Out of the 126 aneurysms, 116 got trimmed effectively, 5 was trapped. Numerous aneurysms in 3 incidents got cured in one craniotomy. Anterior clinoidectomy was removed in 110 cases. Aneurysm residues were found after 1 giant aneurysms clipping. One case lost his sight with preoperative visual light perception and in eight cases cerebral infarction occurred. Type I (dorsal projection) aneurysms constituted 47.5%, Type II aneurysms (34.7%) followed by Type III aneurysms constituted 17.8%. All the others had a good recovery.

Conclusions: The paraclinoid aneurysm can be exposed and treated very well by microsurgery through frontal lateral approach which has the advantages such as minimal invasion, less effect on the patient’s look and simple procedure. The lateral transfrontal approach is safe and effective in surgery for paraclinoid aneurysm. Among the 3 types, type I can reach better prognosis.