To explore the clinical application effect of balloon-assisted blocking technique in clipping surgery for large paraclinoid aneurysms recurrent after embolization.

The clinical data of 10 patients with recurrent large paraclinoid aneurysms after embolization who were admitted to the Department of Neurosurgery of Zhongnan Hospital of Wuhan University from July 2017 to June 2020 were retrospectively analyzed. The maximum diameter of the aneurysm was 17.5±5.6 mm (11-26 mm). All 10 cases of aneurysms underwent craniotomy and clipping with balloon-assisted blocking technique, and the balloon placement and craniotomy and clipping were performed simultaneously in a one-stop hybrid operating room. Immediately after operation, digital subtraction angiography (DSA) was performed to observe the clipping condition of the aneurysm and the patency of the parent artery. During the follow-up period, DSA examination was performed to evaluate the occlusion and recurrence of the aneurysm; the modified Rankin scale (mRS) was used to evaluate the outcomes of the patients.

In all 10 cases of aneurysm, a balloon was successfully placed and the neck of the aneurysm was blocked, and the residual coil and thrombus at the neck of the aneurysm were safely removed, and the aneurysm was successfully shaped and clipped. Immediately after the operation, DSA examination showed that all 10 cases of aneurysms were completely occluded, and there were no residual aneurysms, parent artery stenosis, or large vessel embolism, and no death cases occurred. There were 7 cases with mRS score of 0 and 3 cases with mRS score of 1 at discharge. No delayed visual impairment occurred in any of the patients. The follow-up time of 10 patients was 29.7±8.5 months (13-48 months). DSA reexamination at 6 months after operation showed that the aneurysm was completely occluded in all patients, and there was no residual aneurysm or recurrence. At the last follow-up, the mRS score was 0 in 9 cases and 1 in 1 case.

For large paraclinoid aneurysms that recur after embolization, surgical clipping with balloon-assisted blocking technique has a high success rate, fewer postoperative complications, and good prognosis, which seems to be a safe and effective hybrid surgery method.

Intracranial aneurysm; Microsurgery; Endovascular procedures; Treatment outcome; Balloon-assisted technique; Hybrid surgery