Bilobulated paraclinoid aneurysm mimics double aneurysms: a comparison of endovascular coiling and surgical clipping treatments.

This report presents two cases of subarachnoid hemorrhage caused by rupture of paraclinoid aneurysms. Both aneurysms presented a bilobulated appearance upon image study. Both cases were treated successfully, the first with surgical clipping and the second with endovascular coiling. The special bilobulated feature of paraclinoid aneurysm in this particular anatomic location suggests its close relationship with the carotid dural ring. This relationship caused varying degrees of difficulty in both coiling and clipping the aneurysm. We compared the limitations and advantages of both treatments, and suggest that surgical clipping may be the treatment of choice in this region.