Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery

Object. Because of the anatomical complexity of the paraclinoid region, the surgical treatment of aneurysms arising in the C-6 segment of the internal carotid artery is extremely challenging. The authors' aim in this study was to describe the extended clinical follow-up and assess the short-term and long-term effectiveness of surgical treatment for these aneurysms, focusing on the clinical outcome and degree of aneurysm occlusion and recurrence. Methods. The authors retrospectively analyzed the clinical records for patients treated surgically between 1973 and 2004 at the University of Rome, "La Sapienza." Aneurysms were classified into the following 3 groups according to the site where they arose: the anteromedial, anterior or anterolateral, and posteromedial wall of the C-6 segment. Results. Of the 108 aneurysms in 104 patients treated, 63 (58%) were large or giant. Eighty-eight aneurysms in 84 patients were clipped, 16 underwent a high-flow bypass, 2 were trapped, 1 was wrapped, and 1 was left untreated. The mean follow-up was 126 months; 47 patients had a follow-up of > 10 years. Of the 88 aneurysms that were clipped, 6 (6.8%) had an incomplete occlusion that required an immediate reoperation in 1 case and at 2 years in another. Overall 6 patients (5.8%) had surgery-related permanent complications. Conclusions. Mortality and morbidity rates depend mainly on the patient's preoperative Hunt and Hess grade subarachnoid hemorrhage, whereas surgical morbidity principally reflects excessive manipulation of the optic nerve or ischemic problems due to excessive temporary trapping undertaken without adequate neuroprotection. In expert hands, surgery (clipping and bypass procedures) is a definitive treatment for C-6 aneurysms and has an acceptable complication rate.