Surgical nuances of giant paraclinoid aneurysms.

Paraclinoid aneurysms constitute formidable surgical challenge. The complex surgical anatomy and several factors such as size and projection of the lesion, choice of the surgical approach, relationships between the aneurysm and perforator vessels, site of proximal control, and potential improvement or worsening of visual symptoms account for these difficulties. In such complex cases, surgical nuances frequently determine the final outcome. In this paper, the authors present a comprehensive review of the tricky regional anatomy and describe the operative nuances one of the senior authors (E. dO.) has used to operate on these complex lesions.