Unilateral approach to clip bilateral multiple intracranial aneurysms

In patients harboring bilateral supratentorial aneurysms, the operation has traditionally been accomplished via sequential craniotomies, starting with the side of the ruptured aneurysm. Ideally, if the contralateral aneurysms can be exposed adequately and safely, surgical clipping of all aneurysms via a single, unilateral craniotomy would simplify treatment because the patient could avoid a second craniotomy and anesthesia. We present our technique of the unilateral approach to bilateral multiple intracranial aneurysms.

From September 2005 to December 2006, 8 cases of 12 patients with bilateral multiple intracranial aneurysms were unilaterally approached. All patients selected were under grade 3 according to Hunt-Hess classification. Bilateral posterior communicating aneurysms were the common type in our group. Unilateral pterional approach was adopted. After routinely clipping the ipsilateral aneurysm, dissection to opposite spaces was continued until the exposure of the neck of contralateral aneurysm and proximal and distal contralateral carotid artery, for vascular control.

Total 19 aneurysms of 8 patients were successfully clipped. The patent of all parents' arteries were preserved, particularly the fetal posterior communicating arteries. There was no death associated with this approach in our group.

The advantage of the technique is obvious-the ability to spare the patient the risk and inconvenience associated with a separate craniotomy at the same or different stage. The disadvantage of the technique is that the space of manipulation is deep and narrow. Therefore, it is an alternative approach only for experienced neurosurgeons.