Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Unilateral approach for bilateral clipping of posterior communicating artery aneurysms in a hybrid operating room: A technical note

  • Juan Luis Gomez-Amador (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Pablo David Guerrero-Suarez (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM) ;
  • Jaime Jesus Martinez-Anda (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM) ;
  • Jorge Fernando Aragon-Arreola (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Andrea Castillo-Matus (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Ricardo Marian-Magana (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Marcos V Sangrador-Deitos (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Alan Hernandez-Hernandez (Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez) ;
  • Ernesto Javier Delgado-Jurado (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM) ;
  • Ricardo Santiago Villagrana-Sanchez (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM) ;
  • Abraham Gallegos-Pedraza (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM) ;
  • Jorge Luis Diaz-Espinoza (Department of Neurosurgery, Hospital Regional Toluca - ISSEMyM)
  • Received : 2022.11.30
  • Accepted : 2023.06.23
  • Published : 2023.12.31
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Abstract

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

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References

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