1.Unilateral approach for bilateral clipping of posterior communicating artery aneurysms in a hybrid operating room: A technical note
Juan Luis GÓMEZ-AMADOR ; Pablo David GUERRERO-SUÁREZ ; Jaime Jesús MARTÍNEZ-ANDA ; Jorge Fernando ARAGÓN-ARREOLA ; Andrea CASTILLO-MATUS ; Ricardo MARIAN-MAGAÑA ; Marcos V SANGRADOR-DEITOS ; Alan HERNÁNDEZ-HERNÁNDEZ ; Ernesto Javier DELGADO-JURADO ; Ricardo Santiago VILLAGRANA-SÁNCHEZ ; Abraham GALLEGOS-PEDRAZA ; Jorge Luis DIAZ-ESPINOZA
Journal of Cerebrovascular and Endovascular Neurosurgery 2023;25(4):468-472
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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