The role of internal carotid artery aneurysm clipping in the era of intravascular surgery

INTRODUCTION . The majority of unruptured internal carotid artery aneurysms in the USA, Europe and Asia are treated using endovascular techniques. However, in clinical practice, there are still situations in which clipping of ICA aneurysms remains the only possible method of treatment. We focused on such situations in this study. MATERIALS AND METHODS . We retrospectively analyzed the results of microsurgical treatment of 38 patients with cerebral aneurysms of the internal carotid artery for the period from 2018 to 2024 at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre. Gender distribution: 28 (73.7 %) women, 10 (26.3 %) men. The average age of the patients was 59±12.4 years. Distribution by segments of the internal carotid artery: 26 (68.4.2 %) patients – communicant segment, 5 (13.2 %) patients – choroidal segment, 3 (7.9 %) patients – ophthalmic segment, 4 (10.5 %) patients – internal carotid artery fork region. RESULTS . All patients underwent internal carotid artery aneurysm clipping. Postoperative complications of varying severity were observed in 5 (13.2 %) patients out of 38 . In the group of aneurysms of the ophthalmic segment of the internal carotid artery, 1 out of 3 patients had vision loss in the ipsilateral eye. In the group of aneurysms of the communicating segment of the internal carotid artery, 2 (7.7 %) patients out of 26 had postoperative complications associated with compromise of the anterior choroidal artery orifice. Out of 5 patients in the group of the choroidal segment of the internal carotid artery, 2 (40 %) patients had complications. CONCLUSION . The technology of microsurgical treatment of internal carotid artery aneurysms should not fade away against the background of intravascular treatment, but on the contrary it should develop in step with time and absorb modern technologies that improve the quality of patient treatment.