Prediction of Neurological Outcomes after Treatment of Paraclinoid Aneurysms: A Modern Reappraisal of Microsurgical Techniques

Abstract

Introduction: Microsurgery for paraclinoid aneurysms remains the first line of treatment in select limited-resource settings. The authors aimed to describe their institutional experience and evaluate predictors of good functional outcomes after microsurgical treatment of paraclinoid aneurysms. Methods: A retrospective review of clinical records was conducted. Multivariate logistic regression assessed predictors of neurological outcomes. Results: Fifty-six patients (80.4% female; mean 55.55 ± 11.27 years) with 80 brain aneurysms (72.5% paraclinoid aneurysms) were analyzed. Most paraclinoid aneurysms were located in the ophthalmic segment (53.5%), presented in a ruptured state (56.9%), measured 10-25 mm (65.5%), and had a wide neck [median: 5.2 mm (IQR: 3.07-48)]. The median time from symptom onset to intervention was five days (IQR: 2-20). Preoperative visual deficits were present in 51.8% of patients. Aneurysm repair involved clipping (87.5%) and clipping with bypass surgery (12.5%). Most cases were performed under a minipterional craniotomy (51.8%) and involved the use of extradural anterior clinoidectomy (71.4%), carotid control (92.9%), fluorescein video angiography (91.1%), and intraoperative doppler (89.3%). An increasing Hunt and Hess score at presentation was associated with poor functional outcomes (OR: 0.25, 95% CI 0.03-0.745; p = 0.038). At the 6-month follow-up, 91.1% of patients had good outcomes, and 72.4% had improved visual outcomes. Conclusions: The present series showcases the valuable role of microsurgical treatment for patients with paraclinoid aneurysms in contemporary times. Despite the challenges posed by the poor grade of subarachnoid hemorrhage and delayed intervention, proficiency in adjunct techniques remains essential to optimizing functional outcomes and minimizing surgical morbidity.