Balloon-assisted microvascular clipping of paraclinoid aneurysms: Technical note

William Thorell, Peter Rasmussen, John Perl, Thomas Masaryk, Marc Mayberg

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.

Original languageEnglish (US)
Pages (from-to)713-716
Number of pages4
JournalJournal of neurosurgery
Volume100
Issue number4
DOIs
StatePublished - Apr 2004

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Keywords

  • Balloon occlusion
  • Cerebral aneurysm
  • Paraclinoid aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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