A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm

Jeon, Jin Sue; Ahn, Jun Hyong; Huh, Won; Son, Young-Je; Bang, Jae Seung; Kang, Hyun-Seung; Sohn, Chul‐Ho; Oh, Chang Wan; Kwon, O-Ki; Kim, Jeong Eun

doi:10.1136/jnnp-2013-305019

Cited by 48 publications

(36 citation statements)

References 24 publications

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“…Twenty-one studies reported risk factors for aneurysm growth, including 3954 patients with 4990 aneurysms with 11,000 patient-years and 13,294 aneurysm-years of follow-up. 9,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Eleven of these studies reported the rupture rate of growing aneurysms. Mean patient follow-up was 4.9 years, and median was 3.2 years.…”

Section: Literature Reviewmentioning

confidence: 99%

Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Brinjikji¹,

Zhang²,

Lanzino³

et al. 2015

AJNR Am J Neuroradiol

171

101

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Section: Literature Reviewmentioning

confidence: 99%

Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Brinjikji¹,

Zhang²,

Lanzino³

et al. 2015

AJNR Am J Neuroradiol

171

101

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“…Transitional paraclinoid aneurysms-i.e., aneurysms arising from the clinoid-ophthalmic segment of the ICA and straddling across the DDR with potential risks of subarachnoid hemorrhage-necessitate treatment. 8 Defining the transition of paraclinoid aneurysm from the extradural to intradural spaces can be difficult. Imaging studies that analyze the traditional anatomical landmarks, including the ACP and the origin of the OphA on DSA, 20,22 have been used.…”

Section: Discussionmentioning

confidence: 99%

“…7,8,10,17,18,25 It is important to differentiate the exact location of the paraclinoid aneurysm, whether intradural or not, when considering treatment options. The distal dural ring (DDR) is the anatomical boundary between the intra-and extradural segments of the internal carotid artery (ICA) in the paraclinoid region.…”

mentioning

confidence: 99%

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

Liao

Lin²,

Lin

et al. 2016

JNS

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T he treatment of paraclinoid aneurysms remains challenging. 7,8,10,17,18,25 It is important to differentiate the exact location of the paraclinoid aneurysm, whether intradural or not, when considering treatment options. The distal dural ring (DDR) is the anatomical boundary between the intra-and extradural segments of the internal carotid artery (ICA) in the paraclinoid region. 2,9,19,24 Some studies tried to delineate the DDR with imaging methods and differentiate the aneurysm in the vicinity of the anterior clinoid process (ACP). 5,16,23 However, these studies either lacked direct surgical confirmation or comprised a small case number.aBBreViatiONS ACP = anterior clinoid process; C 4 = cavernous segment; C 5 = clinoid segment; C 6 = ophthalmic segment; CTA = CT angiography; DDR = distal dural ring; DSA = digital subtraction angiography; ICA = internal carotid artery; OphA = ophthalmic artery; OS = optic strut; PDR = proximal dural ring; ROC = receiver operating characteristic; TS = tuberculum sellae. OBJectiVe The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). methOdS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. reSultS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional ane...

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“…Good results have been published in the literature with the use of FDS, with occlusion rates of up to 90% and complications lower than 5%, however surgical clipping remains an acceptable option to achieve high occlusion rates with average complications 1,2,3,4,5,18,19,20 . The purpose of this study is to expose our surgical results and match them with those of the FDS era.…”

mentioning

confidence: 91%

Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

Pahl

Oliveira

Brock

et al. 2016

Arq. Neuro-Psiquiatr.

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Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

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A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm

Cited by 48 publications

References 24 publications

Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

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