Large and giant ventral paraclinoid carotid aneurysms: surgical techniques, complications and outcomes.

OBJECTIVES

Surgical treatment of large and giant ventral paraclinoid carotid aneurysms (vPCAs) continues to be challenging and technically demanding for vascular neurosurgeons. Due to both physiological barriers and limitations of current surgical technology in the treatment of vPCAs, higher rates of morbidity and mortality are a given. To improve the current available data and assess the most effective microsurgical management techniques with the goal of decreased morbidity and mortality, we present this retrospective study of a series of 15 consecutive patients with large and giant vPCAs.

MATERIALS AND METHODS

Between January 2005 and December 2010, fifteen patients presented with large or giant vPCAs were surgically treated at West China Hospital and were included in this study. The data was retrospectively analyzed.

RESULTS

Five men and ten women with an averaging 50 years of age (ranged 32-70 years) were included in this study. The average aneurysm size was 21 mm (ranged 13-36 mm). All patients were treated microsurgically. Twelve patients (80%) had desirable surgical outcomes (Glasgow Outcome Score 4-5) at follow-up for a mean of 32 months (range 3-72 months). One patient (7%) died of severe vasospasm after surgery. The surgical mortality was 7%; overall morbidity was 27%, including the hemiplegia, oculomotor paresis and visual deficit. None of the 14 following patients had rebleeding or regrowth of residual aneurysm during this follow-up period. Age and Hunt-Hess grade were significantly correlated with clinical outcome.

CONCLUSIONS

Despite the difficulties presented by large and giant vPCAs, our increased knowledge of anatomy and refinements in operative techniques and intraoperative monitoring have greatly improved the clinical outcome with a more acceptable mortality and morbidity.