NEUROSURGICAL
FOCUS
VIDEO
Neurosurg Focus 39 (Suppl1):V18, 2015
Microsurgical management of a large ICA bifurcation aneurysm Leonardo Rangel-Castilla, M.D. and Robert F. Spetzler, M.D. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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. KEYWORDS aneurysm; clipping; internal carotid artery terminus; microsurgery; video
SUBMITTED September 3, 2014. ACCEPTED January 27, 2015. INCLUDE WHEN CITING Published online July 1, 2015; DOI: http://thejns.org/doi/abs/10.3171/2015.7.FocusVid.14646. CORRESPONDENCE Robert F. Spetzler, M.D., c/o Neuroscience Publications; Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Road; Phoenix, AZ 85013. email: [email protected]. ©AANS, 2015
Neurosurg Focus Volume 39 • July 2015
1
FOCUS
VIDEO
Neurosurg Focus 39 (Suppl1):V18, 2015
Microsurgical management of a large ICA bifurcation aneurysm Leonardo Rangel-Castilla, M.D. and Robert F. Spetzler, M.D. Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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. KEYWORDS aneurysm; clipping; internal carotid artery terminus; microsurgery; video
SUBMITTED September 3, 2014. ACCEPTED January 27, 2015. INCLUDE WHEN CITING Published online July 1, 2015; DOI: http://thejns.org/doi/abs/10.3171/2015.7.FocusVid.14646. CORRESPONDENCE Robert F. Spetzler, M.D., c/o Neuroscience Publications; Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Road; Phoenix, AZ 85013. email: [email protected]. ©AANS, 2015
Neurosurg Focus Volume 39 • July 2015
1
