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Updated: Aug 1, 2025

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
How I do it: neuromonitoring-guided clipping of high-riding basilar tip aneurysm
Jared W Clouse1, Tejas Karnati1, Dylan J Goodrich1
1Department of Neurological Surgery, University of California, Davis, 4860 Y Street, ACC Suite 3740, Sacramento, CA, 95817, USA.
Background:
Clipping of basilar tip aneurysms presents unique challenges due to the risk of perforator compromise and subsequent disabling stroke.
Method:
Herein, we describe the correct trajectory of the clip applier to clip basilar tip aneurysms through an orbitozygomatic approach to prevent perforator injury and discuss management of intraoperative neuromonitoring changes.
Conclusion:
We anticipate that this video and illustration will aid surgeons as they treat complex wide-necked basilar tip aneurysms with microsurgical clipping.

