J Neurosurg Sci
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The aneurysms of the paraclinoid region are a heterogeneous group of lesions, whose terminology and classification are contradictory because of the complex anatomy and the lack of key anatomical references. A surgical anatomical study to identify an anatomical reference is presented, a new classification of these aneurysms is proposed, and radiological guidelines are given to distinguish an intra from extradural lesion on the x-rays. ⋯ A new classification of the aneurysms of the paraclinoid region which uses the DDR as key anatomical element is proposed. Radiological guidelines able to identify the DDR and, thus, to distinguish intra versus extradural aneurysms are provided.
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Treatment of ophthalmic segment aneurysms is technically demanding and still associated with a relatively high morbidity and mortality. The refinements of surgical techniques combined with the development of indirect methods of treatment have greatly improved the outcome in treating these lesions. We present our clinical experience and discuss treatment strategies. ⋯ Direct obliteration of the aneurysm utilizing advanced surgical techniques is our preferred treatment approach, whenever possible. In case of unclippable large or giant aneurysms, the surgical or endovascular occlusion of the proximal internal carotid artery with or without an extracranial-intracranial by-pass is an option. A highly skilled team including a cerebrovascular and an endovascular surgeon is essential to achieve good outcomes in treating these lesions.