Paraclinoid aneurysms are those that begin in the ophthalmic or clinoidal regions of the internal carotid artery (ICA) and extend posteriorly to the posterior communicating artery (PCoA). Clinoid aneurysms develop between the carotid proximal and distal dural rings. Aneurysms of the internal carotid artery (ICA) that are clinoid or paraclinoid are notoriously challenging to repair with microsurgery. The natural course of these aneurysms differs according to their location and anatomical connections. Accurate preoperative evaluation of these aneurysms’ etiology is consequently essential to their treatment.
Many paraclinoid aneurysms affect a sizable portion of the carotid artery’s circumference, and “reconstructing” an artery by applying clips raises concerns about the long-term behavior of unclipped arterial walls and the degree to which risks are avoided through open clipping.
Any paraclinoid aneurysm that involves the wall of the carotid artery to an extent of 180 degrees or more provides a considerable risk of incomplete clipping and iatrogenic harm to the neighboring anatomical structures. Aneurysms with substantial circumferential artery aneurysmal involvement are better candidates for arterial sacrifice, either with or without bypass or flow diversion. The actual anatomy of the aneurysm, specifically the degree to which the wall of the circumferential carotid artery is involved, is an essential component to take into account when evaluating the potential risks associated with surgical surgery.
Paraclinoid Aneurysm Symptoms
Aneurysms of the paraclinoid artery are typically asymptomatic and are found during treatment for other, unrelated illnesses (frequently headaches). SAH (Subarachnoid Hemorrhage) is the most typical manifestation of paraclinoid aneurysms with symptoms. The next most frequent clinical symptom of these aneurysms is compression of the anterior optic pathway. In certain studies, the prevalence of vision impairment ranges from 25 percent to 33 percent of the population.
The patient’s expected level of vision after treatment is an important factor to take into account while choosing between microsurgery and endovascular administration. When there is a large mass pressing on the optic nerve and there is also a loss of visual field, microsurgery is still the best option for quickly decompressing the optic apparatus and maximizing the chance of visual function recovery.
Paraclinoid Aneurysm Causes
People are sometimes born with aneurysms already present in their bodies. In addition, they appear at any time during life. Although an aneurysm’s cause is frequently unknown, potential causes mostly include:
- A history of aneurysms in the family
- Elevated blood pressure
- An aortic injury
- Atherosclerosis (narrowing of the arteries)
Certain variables increase the likelihood of developing a certain form of an aneurysm. In comparison to females, men are more prone to get aneurysms. Elderly people are also at risk. Possible additional elements are:
- Consumption of a diet rich in saturated fats and cholesterol.
- A history of cardiac diseases and heart attacks in the family.
- Pregnancy also raises the chance of a spleen aneurysm.
Paraclinoid Aneurysm Treatment
The complicated structure of the paraclinoid internal carotid artery (ICA) makes surgical treatment of aneurysms originating from this section challenging. Effective surgical management of these lesions requires getting control of the proximal artery, exposing the aneurysm neck, and obliterating the aneurysm with minimum manipulation of the optic nerve. It is crucial to determine the surgical technique based on an accurate preoperative evaluation of the lesions’ origin.
Surgical repair of intracranial ophthalmic segment aneurysms is challenging due to the anatomical intricacy of the paraclinoid area. Nonetheless, some studies reveal that endovascular and surgical clipping is equally effective in terms of better visual outcomes, while others demonstrate that clipping improves visual outcomes. It is also demonstrated in a comprehensive review that surgical cutting produced better visual outcomes. However, it’s also crucial to recognize that there is a chance of vision loss after microsurgery.