Risk factors for visual impairments in patients with unruptured intradural paraclinoid aneurysms treated by neck clipping without bypass surgery

• Published in: World neurosurgery 2016-07, Vol.91, p.183-189
• Main Authors: Matsukawa, Hidetoshi, M.D., Ph.D, Tanikawa, Rokuya, M.D, Kamiyama, Hiroyasu, M.D, Tsuboi, Toshiyuki, M.D., Ph.D, Noda, Kosumo, M.D, Ota, Nakao, M.D, Miyata, Shiro, M.D., Ph.D, Takeda, Rihei, M.D, Tokuda, Sadahisa, M.D
• Format: Article
• Language: English
• Subjects: Aged; Female; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Middle Aged; Neck clipping; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - statistics & numerical data; Paraclinoid aneurysm; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Risk factors; Vision Disorders - epidemiology; Vision Disorders - etiology; Visual impairments
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.04.004

Abstract Object Although paraclinoid aneurysms are now frequently referred for endovascular treatment, the durability of obliteration is still to be determined. Therefore, direct surgery for paraclinoid aneurysms still remains indispensable. The present study aimed to evaluate the risk factors for the visual impairments in patients with unruptured intradural paraclinoid aneurysm. Methods Authors evaluated the data of 133 patients with 136 aneurysms treated by neck clipping without bypass surgery. Visual impairments included decreased visual acuity and visual field defect. The aneurysm was classified into superior projecting aneurysm, ventral projecting aneurysm, and carotid cave aneurysm. Plug-in method was defined as filling interspace, which was formed between internal carotid artery and sutured dura in case of detachment of dural ring, by some materials. Results Postoperative new visual impairments were observed in 30 aneurysms (22%). During follow up period (median, 600 days), postoperative new visual impairments continued in 23 aneurysms (17%). Multivariate analysis showed that carotid cave location and plug-in method were related to new visual impairments at 30-day (odds ratio (OR), 2.6; 95% confidence interval (CI), 1.1-6.1; p = 0.031 and OR, 4.1; 95% CI, 1.4-12; p =0.008) and at 6-month (OR, 4.1; 95% CI, 1.5-11; p = 0.005 and OR, 3.3; 95% CI, 1.1-11; p =0.045). Conclusions The present study showed that carotid cave location and plug-in method during dural closures were related to postoperative continued visual impairments. Neurosurgeons should carefully consider the surgical indication for unruptured carotid cave location aneurysms and avoid plug-in method.