Introduction Treatment of Paraclinoid aneurysms remains a technical challenge because they occupy a tiny region packed with critical structures, including the C5 and C6 segments of ICA, their branches, and the optic apparatus, cavernous sinus.

Aim of Study Compare endovascular and microsurgical treatment of internal carotid artery aneurysms

Methods In the last 2.5 years, we treat 52 patients with ICA aneurysms.

18 (34%) patients underwent endovascular treatment and in 34 patients (66%), microsurgical clipping was done.

Results CTA images with 3D reformatting can very helpful in evaluating the association of aneurysm with ACP and the need for clinoidectomy during a microsurgical approach.

In cases of microsurgical clipping, if clinoidectomy is essential for proximal control or aneurysm exposure, therefor cervical carotid must be prepared for proximal control.

In our endovascular group, according to the aneurysm neck and aspect ratio, we treat a patient with primary coiling, stent assists coiling, and flow diverting stent.

In Our case series, P.com is the most location for aneurysm formation and rupture.

While more than 90% of P.com aneurysms are microsurgically treated, 70% of ophthalmic aneurysms are treated with an endovascular approach.

In long-term follow-up, 90% of our patients have GOS 4 and 5, 2% have GOS 3 and 8% have GOS 1 or 2; that is not different in the endovascular or microsurgical group.

Conclusion Treatment of ICA aneurysms requires precise anatomical evaluation and a multi-disciplinary approach.

Both endovascular and microsurgical approaches are effective and have the same result.

Disclosure of Interest Nothing to disclose