Optic Foraminotomy versus Anterior Clinoidectomy for Small Superior-Projecting Paraclinoid Aneurysms: Visual and Angiographic Outcome Evaluation

INTRODUCTION: Optic foraminotomy (OF) has been recently proposed as an alternative to anterior clinoidec-tomy (AC) for selected types of paraclinoid aneurysms. In this study, OF and AC were compared for small superior -projecting paraclinoid aneurysms assuming visual and angiographic results as outcome measures. Indications for OF are also discussed. -METHODS: Data of patients who underwent surgery for a paraclinoid aneurysm in the last 10 years were collected across 3 tertiary hospitals. Small to regular-size and superior projecting aneurysms were sorted. Multiple and complex aneurysms were excluded. Records of patients who went through OF were compared with those of patients who un-derwent AC. Neurologic outcome was reported as a modified Rankin Scale. Aneurysm complete occlusion rate and rate of approach-related worsened vision were selected as outcome measures of efficacy and safety, respectively, of the OF versus AC. Unpaired t test and c2 test were used for numerical and categorical variables, respectively. A P value less than 0.05 was considered statistically significant. -RESULTS: OF and AC groups involved 18 and 25 patients, respectively. Complication rate, overall neurologic outcome, rate of approach-related worsened vision, and complete occlusion rate did not differ between the groups. The average follow-up was 51 +/- 34 and 60 +/- 41 months in the OF and AC groups, respectively.CONCLUSIONS: Compared to AC, OF did not show either a higher rate of approach-related worsened vision or a lower aneurysm complete occlusion rate. OF can be considered a valid alternative to the AC for small superior -projecting dorsal ICA wall paraclinoid aneurysms.