caa a22 4500 60621352X CHVBK 20210128101048.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s00701-014-2251-1 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2251-1 Visual outcomes of endovascular and microsurgical treatment for large or giant paraclinoid aneurysms [Elektronische Daten] [Tatsuya Shimizu, Isao Naito, Masanori Aihara, Hiroya Fujimaki, Ken Asakura, Naoko Miyamoto, Yuhei Yoshimoto] Background: The optimal treatment for large or giant paraclinoid aneurysms is still controversial. The present study evaluated the results of endovascular coiling and microsurgical clipping with special reference to visual outcomes. Methods: The clinical data and treatment outcomes of 39 cases of large (>15mm) paraclinoid aneurysms were retrospectively reviewed. Presenting symptoms were subarachnoid hemorrhage in 16 aneurysms and visual impairment in 18. Twenty-one aneurysms were treated by endovascular therapy and 18 were treated by direct surgery. Results: Maximal aneurysm diameter ≥25mm and preoperative visual acuity <20/100 were significantly related to poor visual outcome in univariate analysis. However, preoperative visual acuity was the only significant prognostic factor in multivariate analysis (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.01-0.95, p = 0.04). Although patients treated with endovascular coiling tended to have more favorable outcome than those with surgical clipping, adjustment for other confounding factors reduced the OR of favorable outcome following each treatment modality to nearly one (OR 1.14, 95% CI 0.17-7.46, p = 0.89). Deteriorations in the visual field showed different patterns: upper visual field deficit after endovascular coiling, and inferior nasal quadrantanopia after microsurgical clipping. Conclusions: Preoperative visual acuity was the only independent predictor of visual outcome in patients with large paraclinoid aneurysms. Although adjusted visual outcomes with microsurgical clipping and endovascular coiling were almost the same, selection of the optimal treatment for each aneurysm is essential with recognition of the potential risks and mechanisms of visual impairment. Springer-Verlag Wien, 2014 Visual outcome nationallicence Large/giant aneurysms nationallicence Paraclinoid carotid artery aneurysms nationallicence Clipping nationallicence Coiling nationallicence Shimizu Tatsuya Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut Naito Isao Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan aut Aihara Masanori Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut Fujimaki Hiroya Department of Neurosurgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan aut Asakura Ken Department of Neurosurgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan aut Miyamoto Naoko Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan aut Yoshimoto Yuhei Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 13-20 0001-6268 157:1<13 2015 157 701 https://doi.org/10.1007/s00701-014-2251-1 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2251-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Shimizu Tatsuya Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Naito Isao Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Aihara Masanori Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Fujimaki Hiroya Department of Neurosurgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Asakura Ken Department of Neurosurgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Miyamoto Naoko Department of Neurosurgery, Geriatrics Research Institute and Hospital, Maebashi, Gunma, Japan aut NATIONALLICENCE 700 1- Yoshimoto Yuhei Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, 371-8511, Maebashi, Gunma, Japan aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 13-20 0001-6268 157:1<13 2015 157 701