Paraclinoid carotid aneurysms

Paraclinoid aneurysms originate from the internal carotid artery between the distal dural ring and the posterior communicating artery. Giant, multiple and bilateral aneurysms are more frequent in this group of aneurysms. Surgical clipping of these aneurysms is technically challenging due to the adjacent bony anatomy and neurovascular structures. Operative mortality has been reduced substantially due to advances in microsurgical techniques. However, there is still no uniformity with respect to the surgical procedures used, especially regarding the use of skull-base approaches and resection of the anterior clinoid process. Due to the complexity of these aneurysms, endovascular procedures are used frequently to treat these aneurysms. We have reviewed the anatomical, radiological aspects and classification of paraclinoid aneurysms. Surgical and endovascular management options are also reviewed.