Preliminary Results of Paraclinoid Aneurysm Clipping With Indocyanine Green-Video Angiography: A Single-Center Experience in Vietnam.

Abstract

There are 2 main treatments for unruptured paraclinoid aneurysms: endovascular procedures and surgical clipping. Recent advancements such as intraoperative indocyanine green video angiography (ICG-VA) are improving the safety of clipping procedure in the surgical center without intraoperative imaging. This study is a single-center experience in Vietnam to evaluate the preliminary result of a surgical series in paraclinoid aneurysms with ICG-VA. We performed a retrospective study of 53 unruptured paraclinoid aneurysms who underwent clipping surgery from 2019 to 2023 at the University Medical Center, Ho Chi Minh City. All patients achieved good functional outcomes at 3 months follow-up with no mortality, and 60% of visual symptoms improved postoperatively. There were no statistically significant differences in neurological complications and radiological results between groups A (no ICG-VA) and B (using ICG-VA). Statistically significant differences were only observed in the rate of ischemia detected on computed tomography scan (P = 0.031). The rate of incompleted clipping was 18.9%, with the only significant factor for incompleted clipping being a larger maximal diameter (P = 0.044). Surgical clipping of unruptured paraclinoid aneurysms is a safe and feasible treatment, and good neurological outcomes can be achieved. Applying ICG-VA has provided intraoperative real-time visualization and the potential to decrease complications. The incomplete clipping rate of aneurysms in this position is still a challenge to overcome and several factors can predict this important issue.