Intradural versus Extradural Anterior Clinoidectomy: Comparison of Visual Loss in Patients with Paraclinoid Aneurysms

Abstract Introduction Visual deficit after surgical treatment for paraclinoid aneurysms is a problem faced by many neurosurgeons. Anterior clinoidectomy, performed to access the aneurysm, is one the most important steps of the surgery. However, it is also the step related the most with lesions to the optic nerve. The aim of this study was to compare the rate of visual loss between extradural versus intradural clinoidectomy in patients harboring paraclinoid aneurysms which underwent open surgery. Methods Analysis of 36 patients harboring paraclinoid aneurysms operated by the senior authors between 2020–2022. We compared our results to other series published previously. Results Fifteen patients underwent intradural clinoidectomy (41.6%), twenty patients extradural clinoidectomy (55.5%) and one patient intra and extradural clinoidectomy (2.7%). The incidence of postoperative visual deterioration was 11.1% (4 patients), all of them were from the extradural clinoidectomy group. Other complications found were cerebrospinal fluid leak (1 patient) and vasospasm followed by diffuse ischemia (1 patient). Visual evoked potential was used in 6 patients (16.6%). In two cases VEP was normal during surgery, however they developed visual deterioration in the postoperative period. Conclusion Both techniques have advantages and disadvantages, however extradural clinoidectomy showed higher rates of visual deterioration than intradural clinoidectomy. Regardless of the chosen procedure, precise surgical technique is mandatory when dealing with paraclinoid aneurysms.