• José Luis Acha Sánchez, Jhon E Bocanegra-Becerra, Luis Contreras Montenegro, Adriana Bellido, Shamir Contreras, and Oscar Santos.
• Department of Neurosurgery, Hospital Nacional Dos de Mayo, Lima, Peru.
• World Neurosurg. 2025 Jan 19: 123694123694.

IntroductionMicrosurgery for paraclinoid aneurysms remains the first line of treatment in resource-constrained settings. The authors describe their institutional experience and evaluate functional outcomes after microsurgical treatment of paraclinoid aneurysms.MethodsA retrospective review of clinical records was conducted. Multivariate logistic regression assessed predictors of neurological outcomes.ResultsFifty-six patients (80.4% female; mean age: 55.55 ± 11.27 years) with 58 paraclinoid aneurysms were analyzed. Most paraclinoid aneurysms were located in the ophthalmic segment (53.5%), presented in a ruptured state (56.9%), measured 10-25 mm (65.5%), and had a wide neck [median: 5.2 mm (IQR: 3.07-48)]. The median time from symptom onset to intervention was five days (IQR: 2-20). About 51.8% of patients presented with visual deficits. Aneurysm repair involved clipping (87.5%) and clipping with bypass surgery (12.5%). Most cases were performed under a minipterional craniotomy (51.8%) with extradural anterior clinoidectomy (71.4%), carotid control (92.9%), fluorescein video angiography (91.1%), and intraoperative doppler (89.3%). The intraoperative aneurysm rupture rate was 7.1%. An increasing Hunt and Hess score at presentation was associated with poor functional outcomes (OR: 0.25, 95% CI 0.03-0.745; p = 0.038). At the 6-month follow-up, 91.1% of patients had good outcomes (modified Rankin Scale score ≤ 2), and 72.4% had improved visual outcomes.ConclusionsThe present series showcases the valuable role of microsurgical treatment for patients with paraclinoid aneurysms. Despite the challenges posed by the poor grade of subarachnoid hemorrhage and delayed intervention, microsurgical techniques remain essential to optimizing functional outcomes and minimizing surgical morbidity.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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