Multiple Paraclinoid Aneurysms and Basilar Tip Clipped by the Same Orbito-Zygomatic Approach: 2-Dimensional Operative Video.

Abstract

The management of multiple intracranial aneurysms poses a significant clinical challenge.¹ Various factors, including the patient's neurologic status, age, risk factors, aneurysm morphology, location, ruptured or unruptured status, availability of equipment, the surgeon's surgical abilities, and patient preferences, influence the choice of treatment modality.² It has been observed that there is a higher risk of rupture during the perioperative period when surgical intervention is performed to treat a ruptured aneurysm.³ Additionally, it is suggested that patients with multiple aneurysms located in both the anterior and posterior circulation are less likely to be treated with a single procedure.⁴ This surgical strategy should be applied in the setting of multiple aneurysms in the anterior and posterior circulation that would, on the other hand, demand multiple interventions.⁵ In an experienced scenario, microsurgery could be a viable option. We present the case of a 58-year-old patient who presented with chronic headaches, a medical history of hypertension, and tobacco use. The patient had no neurologic deficits. During imaging, 5 incidental aneurysms were found. Bilateral ophthalmic aneurysms, one ipsilateral ventral paraclinoid aneurysm, at the bifurcation of the internal carotid artery, and another at the top of the basilar. The aneurysms were clipped with an orbito-zygomatic approach, and the patient had no postoperative neurologic deficit (Video 1). The patient consented to the procedure and publication of her image. No institutional research ethics board approval was required because only intraoperative footage was shown. No identifiable data are displayed except for 2 photographs of the patient's head without the face, which was appropriately consented to.