Clipping of a giant partially thrombosed ophthalmic segment aneurysm

Publication date: Available online 2 April 2019Source: Interdisciplinary NeurosurgeryAuthor(s): Roberto Rodriguez Rubio, Vera Vigo, Rina Di Bonaventura, Olivia Kola, Ricky Chae, Adib A. AblaAbstractOphthalmic segment aneurysms (OSA) originate from the paraclinoid portion of the internal carotid artery (ICA) usually at the origin of the ophthalmic artery. OSAs represent 1.5–10% of intracranial aneurysms, and although often asymptomatic, may lead to optic nerve (ON) compression and/or subarachnoid hemorrhage. When the dome is partially or completely thrombosed, microsurgical clipping can provide vascular exclusion and ON decompression through thrombectomy. Nevertheless, high expertise and knowledge of the regional anatomy are required to manage this complex surgical field.In this operative video, we show the management of a giant thrombosed OSA. The 52-year-old male patient presented with a recent history of worsening headache and progressive right visual loss. Neuroimaging revealed a 3 cm partially thrombosed right OSA, with mass effect on the ON and surrounding edema. An incidental 5 mm right middle cerebral artery (MCA) bifurcation aneurysm was also identified. Endovascular occlusion was not feasible, and the patient agreed to microsurgical treatment. A right pterional craniotomy was performed and the sylvian fissure was split, exposing both lesions. Parent vessel control was achieved with temporary clipping of the cervical ICA, and distal to the origin of the aneurysm...
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research