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Entire orifice blocking-assisted microsurgical treatment: clipping of intracranial giant wide-neck paraclinoid aneurysms
EANS Academy. Ma L. Sep 27, 2019; 275974; EP01078
Abstract
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Objective: Giant wide-neck paraclinoid aneurysms remain a formidable challenge for neurosurgeons due to the brisk retrograde blood flow during surgical clipping. Theoretically, Entire orifice blockade (EOB) by placing a longitudinal intracarotid balloon catheter across the aneurysm neck could achieve a good vascular control in treating cerebral aneurysms, but related studies have been scarce. The aim of this study was to evaluate the safety and efficiency of the EOB-assisted microsurgical technique for treating giant wide-neck paraclinoid aneurysms.
Methods: Clinical data and treatment summaries of patients with giant wide-neck paraclinoid aneurysms who underwent EOB-assisted microsurgical clipping were
retrospectively reviewed.
Results: A total of 26 patients were analyzed. All but 3 patients harbored unruptured aneurysms. The mean largest diameter of the aneurysms was 26.8 mm, and the mean neck size was 12.5 mm. All lesions were successfully clipped without residual aneurysms. Post-operative images revealed no major branch occlusion due to thromboembolic complications. Four patients presented neurologic deficits caused by vasospasm, 3 of which were completely resolved by postoperative treatment. At a mean follow-up time of 1.86 years (range, 0.5-3.5 years), none of the patients died, and 96.2% (n =25) of the patients had favorable clinical outcomes with modified Rankin Scale values of 0-2.
Conclusion: For patients with giant wide-neck paraclinoid aneurysms, EOB-assisted microsurgical clippingis a safe and useful procedure for obtaining vascularcontrol, for softening and shrinking the aneurysm sac and for providing a wide and clean operative field that allows the clip to be effectively placed.
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