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Updated: Jan 27, 2026
18:50
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
14.0K
Microsurgical Technique for Basilar Apex Aneurysm Clipping: Two-Dimensional Video
Miguel Angel Lopez-Gonzalez1, Fransua Sharafeddin2, Timothy Marc Eastin1
1Department of Neurosurgery, Loma Linda University, School of Medicine, Loma Linda, California, USA.
World Neurosurgery
|March 14, 2019
Summary
Surgical clipping successfully treated a wide-neck basilar apex aneurysm and an associated anterior communicating artery aneurysm in a hypertensive smoker. Complete exclusion was confirmed at 1-year follow-up, with full recovery from temporary oculomotor nerve palsy.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- A 57-year-old female presented with hypertension, smoking history, and headaches.
- Imaging revealed an unruptured 8-mm wide-neck basilar apex aneurysm and a 3-mm anterior communicating artery aneurysm.
Observation:
- Surgical clipping was chosen over endovascular treatment due to aneurysm characteristics and anatomical space.
- A cranio-orbito-zygomatic craniotomy with anterior clinoidectomy facilitated access for basilar apex aneurysm clipping.
- Temporary clipping of the basilar trunk allowed for safe aneurysm obliteration.
Findings:
- The basilar apex aneurysm was successfully clipped, followed by clipping of the anterior communicating artery aneurysm.
- Intraoperative angiography and Micro-Doppler confirmed complete aneurysm exclusion and patent parent vessels.
- The patient experienced transient partial oculomotor nerve palsy, which resolved completely within 2 weeks.
Implications:
- Surgical clipping is a safe and effective treatment for complex basilar apex aneurysms, even with associated lesions.
- Minimally invasive techniques, including anterior clinoidectomy, enhance surgical exposure and safety.
- Complete aneurysm exclusion achieved via surgical clipping offers a definitive treatment option with favorable long-term outcomes.
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