Treatment of giant paraclinoid aneurysms. Own experience.

OBJECTIVES: The incidence of giant aneurysms in the paraclinoid section of the internal carotid artery (ICA) is low. They manifest their occurrence by subarachnoid haemorrhage and neurological and hormonal symptoms, resulting from compression on either the nervous structures or on the pituitary. The treatment of these aneurysms is a challenge for the surgeon, due to a difficult access, high operational risk and when the size of operated malformations is large.

MATERIAL AND METHODS: Between the years 1994 and 2001, twenty (20) patients with giant paraclinoid aneurysms of the carotid artery were submitted to: endovascular treatment - 7 patients and to microsurgery - 13 patients. The treatment, following the access to the aneurysm and consisting in short-time (temporary) endovascular occlusion of ICA, was applied in some cases, while trapping was the method of choice in other cases.

RESULTS: Good results of the endovascular treatment were obtained in 6 patients and, in one (1) case, satisfactory result was observed. Regarding the whole study group, hormonal symptoms (amenorrhoea) occurred in one case only. Four aneurysms were totally embolized, 1 - almost totally and 2 - partially. Recanalisation was observed in one case after 2 years. In the surgical method, good and very good results were obtained in 10 patients and satisfactory results - in 3 patients.

CONCLUSION: Application of either the endovascular method or of the microsurgical method - or of both these methods - used individually in case of a given aneurysm, increases the chances for an effective occlusion with a lower operative risk.