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Updated: Jul 4, 2025
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Frontotemporal craniotomy with orbital osteotomy for superior hypophyseal artery aneurysm clipping
Grant Arzumanov1, Seung W Jeong1, Bhavika Gupta1
1Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Insights
Surgical clipping of rare superior hypophyseal artery aneurysms is challenging. This case study details exoscope-assisted clipping techniques for a ruptured aneurysm, offering a novel approach for complex neurosurgical cases.
Area of Science:
- Neurosurgery
- Vascular Neurosurgery
- Cerebrovascular Surgery
Background:
- Superior hypophyseal artery (SHA) aneurysms are uncommon paraclinoid aneurysms.
- These aneurysms carry a significant mortality risk (3%-6%).
- Surgical clipping is technically demanding due to complex surrounding anatomy, and endovascular coiling is often difficult.
Purpose of the Study:
- To present a case of a ruptured right SHA aneurysm.
- To illustrate the technical nuances of surgical clipping using an exoscope.
- To highlight the exoscope as a potentially advantageous tool compared to traditional microscopes for such procedures.
Main Methods:
- Case presentation of a ruptured right SHA aneurysm.
- Surgical clipping performed using an exoscope.
- Detailed description of the technical aspects and nuances of the exoscope-assisted procedure.
Main Results:
- Successful surgical clipping of the ruptured SHA aneurysm was achieved.
- The exoscope facilitated visualization and manipulation in the challenging surgical field.
- The technical nuances of exoscope application in this specific case were demonstrated.
Conclusions:
- Exoscope-assisted surgical clipping is a viable and potentially advantageous technique for managing superior hypophyseal artery aneurysms.
- This approach may offer benefits in complex neurosurgical cases with challenging anatomy.
- Further investigation into the utility of exoscopes for paraclinoid aneurysms is warranted.
Abstract:
Superior hypophyseal artery (SHA) aneurysms are rare paraclinoid aneurysms with a mortality rate as high as 3%-6%. Surgical clipping of these aneurysms is technically challenging due to the surrounding anatomy. The large size and complicated surrounding anatomy make endovascular coiling very difficult. Here we present the case of a ruptured right SHA aneurysm. The authors present technical nuances of the clipping using an exoscope rather than a traditional microscope. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23157.
