Contralateral approach to bilateral and ophthalmic aneurysms.

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• A previous survey identified a high incidence of fatal rupture in unclipped aneurysms among patients with multiple aneurysms.
• The challenge of treating previously unapproachable aneurysms necessitates advanced surgical strategies.

Purpose of the Study:

• To present a more vigorous surgical technique for accessing and clipping previously unapproachable intracranial aneurysms.
• To evaluate the efficacy and safety of a contralateral surgical approach for specific aneurysm types.

Main Methods:

• The study involved a retrospective review of 39 patients with 43 intracranial aneurysms treated with a contralateral surgical approach.
• Surgical techniques focused on accessing middle cerebral, ophthalmic, posterior communicating artery, and proximal carotid aneurysms from the contralateral side.
• Angiographic findings were correlated with surgical outcomes.

Main Results:

• The contralateral approach was successfully employed for clipping middle cerebral and ophthalmic aneurysms.
• Successful clipping of posterior communicating artery aneurysms in cases of bilateral aneurysms was achieved.
• The technique proved effective for single ophthalmic and medial-pointing proximal carotid aneurysms.

Conclusions:

• The described vigorous surgical technique enables the successful clipping of previously unapproachable intracranial aneurysms.
• The contralateral approach offers a viable solution for managing complex multiple and specific single intracranial aneurysms.
• This method potentially reduces the risk of fatal aneurysm rupture.