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Clipping of Multiple Cerebral Aneurysms Through Cranioorbital Zygomatic Approach: 2-Dimensional Operative Video
Rami O Almefty1, Walid Ibn Essayed2, Ossama Al-Mefty2
1Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
Operative Neurosurgery (Hagerstown, Md.)
|September 12, 2021
Summary
Securing ruptured cerebral aneurysms is crucial. This case study highlights the cranio-orbito-zygomatic (COZ) approach for clipping multiple aneurysms, offering advantages in complex cases where endovascular treatment is suboptimal.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Ruptured cerebral aneurysms carry high morbidity and mortality, necessitating prompt treatment to prevent rebleeding.
- Multiple aneurysms occur in about 20% of cases, often in women, and untreated unruptured aneurysms pose a higher risk after a prior rupture.
Observation:
- A patient with subarachnoid hemorrhage and multiple aneurysms unsuitable for endovascular coiling underwent surgical clipping.
- The cranio-orbito-zygomatic (COZ) approach was utilized to clip three aneurysms: middle cerebral artery, anterior choroidal artery, and superior cerebellar artery.
Findings:
- The COZ approach, including zygomatic osteotomy and clinoidectomy, provided a wider operative corridor by mobilizing neural structures like the temporal lobe, optic nerve, and oculomotor nerve.
- This technique facilitated enhanced visualization, maneuverability, and exposure of critical neurovascular structures, including the clinoidal carotid.
Implications:
- The COZ approach is advantageous for clipping complex aneurysms, particularly in the posterior circulation, by allowing safe dissection and mobilization of vital nerves.
- This surgical technique offers superior exposure and maneuverability compared to other approaches, aiding in the management of complex cerebrovascular diseases.
