Surgical repair of clinoidal segment carotid artery aneurysms unsuitable for endovascular treatment

OBJECTIVE: Clinoidal segment carotid artery aneurysms are surgically challe nging lesions. The aneurysm neck originates proximal to the distal dural ri ng, and the aneurysms typically are larger. Therefore, endovascular techniq ues are often considered to be the primary treatment option. Treatment tech niques and results for 40 clinoidal segment carotid artery aneurysms that w ere considered unsuitable for contemporary endovascular intervention are an alyzed in this report. METHODS: Forty aneurysms in 33 female and 3 male patients were treated surg ically. Fifteen patients had bilateral aneurysms; of these patients, four u nderwent bilateral craniotomies. Twenty-seven aneurysms were 10 to 14 mm in size, eight were 15 to 24 mm, and five were more than 25 mm. The most comm on presentation was visual loss, which occurred in 13 patients. Seven patie nts presented with subarachnoid hemorrhage. RESULTS: Thirty-seven aneurysms were directly repaired with clipping, two w ere trapped with bypass, and one was trapped without bypass. The complicati on rate was 10%, with one major stroke, two minor strokes, and one successf ully treated brain abscess. CONCLUSION: Surgical treatment of clinoidal segment carotid artery aneurysm s can produce acceptable outcomes. Specific preoperative and intraoperative techniques facilitate improved surgical results for aneurysms that are not treatable with contemporary endovascular techniques.