Multiple Aneurysms Clipping Through the Eyebrow Approach: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Vascular Surgery
• Skull Base Surgery

Background:

• The eyebrow approach is a valuable surgical technique for anterior skull base pathologies.
• Multiple aneurysms present unique surgical challenges requiring precise and accessible approaches.

Purpose of the Study:

• To present a case of successful multiple aneurysm clipping using the eyebrow approach.
• To discuss the surgical nuances and key steps of this technique for anterior skull base vascular lesions.

Main Methods:

• A 44-year-old patient with incidentally found middle cerebral artery (MCA) and internal carotid artery (ICA) bifurcation aneurysms underwent surgery.
• A supraorbital eyebrow incision and bone flap were utilized, with extensive drilling to maximize surgical space.
• Microsurgical dissection of the sylvian fissure and cisterns, followed by aneurysm clipping and intraoperative verification with Doppler ultrasonography and indocyanine green angiography.

Main Results:

• The eyebrow approach facilitated simultaneous clipping of two aneurysms at the MCA and ICA bifurcations.
• The surgical procedure was completed with hemostasis achieved and an uneventful postoperative course.
• Key steps included patient positioning, orbital floor drilling, and extensive arachnoid dissection for optimal exposure.

Conclusions:

• The eyebrow approach is a viable and versatile option for simultaneous treatment of multiple anterior circle of Willis aneurysms in selected patients.
• Meticulous surgical technique, including patient positioning and extensive dissection, is crucial for successful outcomes with this approach.