Abstract
Paraclinoid aneurysms are among the most complex for microsurgical treatment. Their proximity to the skull base, need for anterior clinoidectomy, lack of adequate proximal control, and frequent large/giant morphology make microsurgical treatment truly challenging. Recently, after the development of flow diverter stents and subsequent FDA approval for the treatment of paraclinoid aneurysms, microsurgery has virtually been abandoned as a treatment modality for these aneurysms in many centers. However, there are still cases in which open surgical treatment will be necessary, such as ruptured aneurysms, aneurysms with mass effect on the optic pathways, patients allergic to antiplatelet agents, and recurrence after endovascular treatment. In this presentation, case examples will be demonstrated with surgical videos highlighting nuances of the surgical techniques required to manage such lesions. Surgical results (clinical and radiological) of a series of more than 80 patients will be demonstrated.
