Entire Orifice Blocking-Assisted Microsurgical Treatment: Clipping of Intracranial Giant Wide-Neck Paraclinoid Aneurysms

Dolenc approach for clipping of giant C6 and C7 segment aneurysms of the internal carotid artery

Objective

Surgical treatment for giant aneurysms of the ICA-ophthalmic segment (C6) and communicating artery segment (C7) is a challenge for neurosurgeons because of their high risks and poor outcomes. We aim to explore the advantages and disadvantages of the Dolenc approach in the treatment of giant C6-C7 segment aneurysms.

Methods

We retrospectively reviewed the clinical data of 13 cases with giant C6 aneurysms and 4 cases with giant C7 aneurysms treated with the Dolenc approach.

Results

All 17 cases of aneurysms were clipped successfully using the Dolenc approach, of which, 1 case with ipsilateral MCA occlusion underwent extracranial-intracranial artery bypass after the aneurysm clipping. Regarding clinical outcomes, six out of nine cases with preoperative visual impairment improved after surgery, two cases saw no change, and one case deteriorated. Of all the cases, one had new-onset vision loss, four had new-onset oculomotor paralysis, three had surgical side cerebral infarction, and two had diabetes insipidus. DSA or CTA examination within 2 weeks after surgery showed that all aneurysms were completely clipped without residual. After a follow-up of 9-12 months, 17 patients were evaluated based on GOS and CTA examination. A total of 14 cases had GOS 5 scores, 2 cases had GOS 4 scores, 1 case had GOS 2 scores, and no cases had death. None of the patients had recurrence based on CTA examinations.

Conclusion

Through the Dolenc approach, we could achieve more operation space and expose clinoid segments for temporary occlusion. Therefore, the Dolenc approach was shown to be a safe, effective, and feasible treatment for giant C6-C7 aneurysms.

Visualization balloon occlusion-assisted technique in the treatment of large or giant paraclinoid aneurysms: A study of 17 cases series

Objective

Although balloon-assisted techniques are valuable in aneurysm clipping, repeated angiography and fluoroscopy are required to understand the location and shape of the balloon. This study investigated the value of visualization balloon occlusion-assisted techniques in aneurysm hybridization procedures.

Methods

We propose a visualization balloon technique that injects methylene blue into the balloon, allowing it to be well visualized under a microscope without repeated angiography. This study retrospects the medical records of 17 large or giant paraclinoid aneurysms treated by a visualization balloon occlusion-assisted technique in a hybrid operating room. Intraoperative surgical techniques, postoperative complications, and immediate and long-term angiographic findings are highlighted.

Results

All 17 patients had safe and successful aneurysm clipping surgery with complete angiographic occlusion. Under the microscope, the balloon injected with methylene blue is visible through the arterial wall. The position and shape of the balloon can be monitored in real time without repeated angiography and fluoroscopic guidance. Two cases of intraoperative visualization balloon shift and slip into the aneurysm cavity were detected in time, and there were no cases of balloon misclipping or difficult removal. Of 17 patients, four patients (23.5%) experienced short-term complications, including pulmonary infection (11.8%), abducens nerve paralysis (5.9%), and thalamus hemorrhage (5.9%). The rate of vision recovery among patients with previous visual deficits was 70% (7 of 10 patients). The mean follow-up duration was 32.76 months. No aneurysms or neurological deficits recurred among all patients who completed the follow-up.

Conclusion

Our study indicates that microsurgical clipping with the visualization balloon occlusion-assisted technique seems to be a safe and effective method for patients with large or giant paraclinoid aneurysms to reduce the surgical difficulty and simplify the operation process of microsurgical treatment alone.