2025 Proffered Presentations
S351: TEMPORARY BALLOON OCCLUSION FOR UNRUPTURED PARAOPHTHALMIC ANEURYSMS DURING MICROSURGICAL CLIPPING
Ehsan Dowlati, MD; Seok Y Oh, MD; Ahmad A Ballout, MD; Timothy G White, MD; Danielle Golub; Brendan Huang; Henry Woo, MD; Athos Patsalides, MD, MPH; Avi A Setton, MD; Jeffrey M Katz; Amir R Dehdashti, MD; North Shore University Hospital
Background: Proximal vessel control during microsurgical clipping of ophthalmic segment aneurysms (OSAs) is essential in successful and safe clipping of the aneurysm. Use of intraoperative angiography and temporary balloon occlusion (TBO) during clipping of OSAs has been performed in a limited number of cases but may be a feasible and less-invasive method of proximal control compared to proximal cervical internal carotid artery (ICA) control requiring neck dissection. The aim of this study is to explore the safety and efficacy of this method of proximal control as an alternative to surgical control at the cervical ICA.
Methods: This is a retrospective review of all patients from 2013-2023 from a single institution’s experience performing TBO during OSA clipping. Patient demographics, presenting symptoms, aneurysm morphology, peri-operative parameters and postoperative complications and outcomes were analyzed.?
Results: A cohort of 33 patients with 34 OSAs were evaluated. The cohort consisted of females (87.8%) with a median age of 54 years (range: 26 to 71). Headache was the most common presenting symptom (51.5%), followed by incidental identification of an OSA (35.3%). The morphology of the aneurysms was predominantly small (<7mm; 73.5%) with a narrow neck (≤4mm; 57.6%). A balloon guide (Cello or Walrus balloon guide catheter) was positioned in the cervical ICA in all patients prior to aneurysm exposure (Case example in Figure 1). Balloon inflation and TBO during microsurgical clipping was performed for 19 aneurysms. Among the 19 OSAs which underwent TBO during clipping, 63.1% were classified as small (<7mm), 52.6% had a narrow neck size (≤4mm), and 57.9% projected superiorly. Compared to aneurysms that did not use TBO for proximal control, those that did had wider neck size (p = 0.03) and were more likely to require anterior clinoidectomy (33.3% vs. 63.2%). Estimated intraoperative blood loss was lower in patients undergoing TBO (p = 0.04). TBO time ranged from 0.5 to 3 minutes. Mean fluoroscopy time was 7.5 minutes. There was one intraoperative case of ICA vasospasm treated with vasodilators. There were no cases of vessel injury or dissection. There were two postoperative complications, including asymptomatic intraparenchymal hemorrhage, and ipsilateral ischemic stroke causing transient weakness that resolved by discharge.
Conclusion: Balloon catheter-assisted TBO of the proximal ICA during microsurgical clipping of OSAs is a safe and effective procedure to help achieve proximal control and facilitate complete aneurysm occlusion with minimal risk of added complications. This is particularly beneficial for OSAs with wide necks and requiring anterior clinoidectomy.