[Clipping of paraclinoid aneurysms associated with multiple and bilateral aneurysms through contralateral pterional approach].

Objective: To investigate the minimally invasive techniques and the indication of paraclinoid aneurysms associated with other aneurysms' clipping via the contralateral approach. Methods: From January 2011 to January 2015, 9 paraclinoid aneurysms associated with other aneurysms were clipped via contralateral approach at the Department of Neurosurgery, Beijing Tiantan Hospital.The records of these patients were analyzed retrospectively to review the clinical outcome and surgical skills. Results: A total of 20 multiple bilateral aneurysms (9 of contralateral paraclinoid aneurysms, 4 of ICA aneurysms, 4 of posterior communicating artery aneurysms, 2 of anterior communicating artery aneurysms and 1 of anterior cerebral artery aneurysm) from 9 patients were clipped successfully through a unilateral pterional craniotomy.All patients with paraclinoid aneurysms who underwent surgery through contralateral approach showed a good recovery.Postoperative digital subtraction angiography or computerized tomography angiography did not show any residual aneurysm.One patients had ipsilateral olfactory nerve injury during operation.One had cerebral ischemia after surgery, and other patients discharged uneventfully.Of the 1 patients with preoperative visual symptoms showed an improvement. No visual function impairment was observed among others. Conclusions: The contralateral approach remains a safe and reliable treatment option for medial directed paraclinoid aneurysms and those associated with bilateral intracranial aneurysms.For bilateral multiple aneurysms associated this kind of paraclinoid aneurysms, consideration may be given to clipping all aneurysms with the contralateral approach.

[Surgical management of ophthalmic artery aneurysms via minimally invasive frontolateral approach].

Objective: To explore the minimally invasive techniques and outcome of carotid ophthalmic artery aneurysms clipping via a frontolateral approach. Methods: The clinical data of 95 patients with carotid ophthalmic artery aneurysms treated via frontolateral approach in the last 1.5 years in Beijing Tiantan Hospital and Beijing Anzhen Hospital were analyzed retrospectively.Before the operation, digital subtraction angiogram (DSA) was performed among all patients.The patients were divided into two groups by the lateral approach.According to preoperative classification, surgical characteristics and prognosis were summarized. Results: Ninety-five cases of ophthalmic aneurysms were divided into type Ⅰ of 44 cases (46.3%), type Ⅱ of 34 cases (35.7%) and type Ⅲ of 17cases (17.9%), according to the results of DSA.The diameter of aneurysm was <10 mm (35 cases), 10-25 mm (34 cases), and >25 mm (26 cases). In the 17 cases of subarachnoid hemorrhage (SAH), 8 cases were ruptured carotid-ophthalmic artery aneurysms.Among those 95 patients, 93 were clipped successfully, 2 was trapped.Multiple aneurysms in 5 cases were treated in one surgical session through the same approach.No aneurysm residual was found after postoperative CTA review.Ipsilateral vision of 3 cases were decline.Cerebral infarction was appeared in 9 cases.All the others had a good recovery. Conclusions: The carotid-ophthalmic artery aneurysms could be well exposed. Microsurgery through frontolateral approach has the advantages such as minimal invasion, less effect on the patients' look and simple procedure.The frontolateral approach is safe and effective in surgery for ophthalmic segment of the internal carotid artery aneurysms.