Microsurgical and Endovascular Treatments for Aneurysms of the Ophthalmic Segment of the Internal Carotid Artery: A 10-Year Regional Experience

Aneurysms of the ophthalmic segment of the internal carotid artery (ICA) are among the most challenging lesions in cerebrovascular surgery due to their proximity to the optic nerve and skull base structures. To present a 10-year regional experience comparing the microsurgical and endovascular treatments for aneurysms of the ophthalmic segment of the ICA, with emphasis on intra- and extradural clinoidectomy approaches. Retrospective study including patients treated with microsurgical clipping (2016–2025) and elective endovascular therapy (2018–2025). Demographics, aneurysm characteristics, treatment techniques, complications, and mortality were analyzed. A total of 459 patients were included, with 75 undergoing microsurgical treatment and 384 treated endovascularly. In unruptured aneurysms treated microsurgically, complication rate was 3.1% with no mortality. In ruptured cases, complication and mortality rates were 27.3% and 18.2% respectively. In the endovascular group, complication and mortality rates were 2.9% and 0.5% respectively. Intra- and extradural clinoidectomy were performed in 80% and 20% of microsurgical cases respectively. Microsurgical clipping remains a safe and effective option, particularly for ruptured and complex aneurysms. Endovascular therapy has become the preferred treatment for unruptured aneurysms. Mastery of clinoidectomy techniques is essential for optimal surgical outcomes.