Introduction
I have seen few paraclinoid aneurysms clipped without complications. Senior neurosurgeons in the hospital were great, but the aneurysm is challenging. I have never clipped but coiled. The anatomy is complicated and nomenclature is confused. At least for me.
Case presentation
A woman in her early fifties presented with headache. She is a medical assistant in the hospital. A head CT revealed no hemorrhage. I wondered if I should order emergent MRI for a while. Unless she had said transient double vision, I would not. A MRA revealed a left medial paraclinoid aneurysm. I was a little surprised.
An ophthalmologist diagnosed that there were no neurological symptoms caused by compression from the cerebral aneurysm. The patient was admitted for observation. On the fourth day of hospitalization, cerebral angiography was performed.
The aneurysm was round with 6mm diameter. No bleb. I diagnosed no relation between headache and the aneurysm. Thin slice T2 coronal images revealed no attachment.
Strategy
Transradial approach
7Fr Rist; the tip is at the vertical portion of the left ICA, which is the first time.
Phenom plus; the tip is at the horizontal portion.
Coil; 6mm x 20cm. VER 8.9%.
Flow diverter; 4.25 x 18cm. From just proximal to the take-off of the pcom to the proximal edge of the horizontal portion.
References
- Krisht AF. Paraclinoid aneurysms: part IV-medial aneurysms. Contemporary neurosurgery. 2019.
- Javalkar V. Paraclinoid aneurysms. Journal of clinical neuroscience. 2011.
- Maeoka K. Optimal coil packing density for aneurysmal complete obliteration in flow diversion stenting: a retrospective study. Stroke: vascular and interventional neurology. 2025.
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