Microneurosurgical management of carotid-ophthalmic aneurysms

ObjectiveTo evaluate the management of carotid-ophthalmic segment aneurysms (COA) with modern microneurosurgical techniques and instruments.MethodSixty patients with COA undergoing microsurgical clipping between March 1994 and June 2002 in the Department of Neurosurgery, Tiantan Hospital, Beijing, were analyzed retrospectively. Neuroimaging included digital subtraction angiography (DSA), MRI, CT, three-dimensional CT angiography and three-dimensional DSA. From 1998, intraoperative Doppler ultrasound monitoring and endoscope-assisted techniques were used.ResultAll aneurysms were completely obliterated without either recurrence or death. The morbidity rate of surgery prior to 1998 was 21.7%, which decreased to 13.7% after 1998 (mean 18.3% for the whole study period).ConclusionPreoperative planning based on neuroimaging is very valuable. Advances in neuroimaging, endoscope-assisted techniques and intraoperative Doppler ultrasound monitoring are useful to decrease postoperative complications. Microneurosurgical techniques are optimal for the management of COA with ever lessening morbidity.