Microsurgical management of a large ICA bifurcation aneurysm

A 70-year-old man with progressive visual disturbances, left superior quadrantanopsia, and right-sided papilledema underwent imaging that demonstrated a right internal carotid artery (ICA) terminus aneurysm with third-ventricle mass effect and ipsilateral optic nerve and chiasm compression. We perfo...

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Bibliographic Details
Published inNeurosurgical focus Vol. 39 Video Suppl 1; no. videosuppl1; p. V18
Main Authors Rangel-Castilla, Leonardo, Spetzler, Robert F
Format Journal Article
LanguageEnglish
Published United States 01.07.2015
Subjects
Aged
Carotid Artery, Internal - surgery
Cerebral Angiography
Humans
Intracranial Aneurysm - complications
Intracranial Aneurysm - surgery
Male
Microsurgery - instrumentation
Microsurgery - methods
Surgical Instruments
aneurysm
clipping
video
internal carotid artery terminus
microsurgery
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Summary:A 70-year-old man with progressive visual disturbances, left superior quadrantanopsia, and right-sided papilledema underwent imaging that demonstrated a right internal carotid artery (ICA) terminus aneurysm with third-ventricle mass effect and ipsilateral optic nerve and chiasm compression. We performed a right modified orbitozygomatic craniotomy, with proximal control and dissection of the aneurysm and small perforator arteries. Temporary ICA and anterior cerebral artery (ACA) clips allowed placement of a large curved permanent clip, reconstructing the ICA bifurcation and maintaining adequate patency of the ACA and middle cerebral artery. Complete aneurysm obliteration was confirmed by intraoperative indocyanine green angiography and postoperative CT angiography. The video can be found here: http://youtu.be/5WEEgmA-g2A.
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ISSN:1092-0684
1092-0684
DOI:10.3171/2015.7.FocusVid.14646