Surgical treatment of large paraclinoid
aneurysms remains technically challenging due to the adjacent bony anatomy and neurovascular structures. Endovascular retrograde suction
decompression using a double-lumen balloon
catheter facilitates
clip ligation of the
aneurysm. Video 1 demonstrates a large paraclinoid
aneurysm that was treated with endovascular balloon occlusion and retrograde suction
decompression in a hybrid operating room. A 49-year-old woman presented with progressively worsening
headache. Computed tomography angiography demonstrated a large 16-mm left paraclinoid
aneurysm. Neurologic examination showed no deficits. Angiography with compression of the left carotid artery showed the collateral blood flow through the posterior communicating artery. The
aneurysm was exposed via the pterional transsylvian approach. A double-lumen balloon guide
catheter was placed in the left internal carotid artery. Considering the risk of ischemic complications, the "trapping-evacuation" technique was not used. After balloon inflation, a temporary
clip was placed on the posterior communicating artery. Retrograde suction through the guide
catheter decreased the intra-aneurysmal pressure. Tandem clipping with fenestrated clips was used to occlude the
aneurysm and reconstruct the parent artery. Postoperative angiography confirmed complete obliteration of the
aneurysm, and the patient recovered without any
neurologic deficits. Endovascular balloon occlusion obviated the need for cervical dissection of the internal carotid artery. Retrograde suction
decompression and intraoperative angiography facilitated surgical clipping for large and giant paraclinoid
aneurysms.