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Published on: August 11, 2015
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Simultaneous Microsurgical Clipping of Bilateral Intracranial Aneurysms
Samuel A Tenhoeve1, Cody J Orton1, Kyril L Cole1
1Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
World Neurosurgery
|August 8, 2025
Summary
Simultaneous surgical clipping of bilateral intracranial aneurysms (IAs) via a single craniotomy is a safe and effective treatment option. This approach can avoid multiple procedures and long-term dual antiplatelet therapy in select patients with surgically accessible IAs.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Intracranial aneurysms (IAs) affect 3%-6% of adults, with multiple IAs increasing rupture risk.
- Treatment decisions for multiple IAs depend on patient/aneurysm factors and surgical efficiency.
- Bilateral IAs present complex management challenges, necessitating careful consideration of treatment strategies.
Purpose of the Study:
- To demonstrate the technical nuances of simultaneous clipping of bilateral intracranial aneurysms.
- To evaluate the feasibility and outcomes of a single-stage open surgical approach for bilateral IAs.
- To highlight the benefits of this approach in selected patients regarding procedural efficiency and reduced complications.
Main Methods:
- A case study detailing the simultaneous clipping of a right posterior communicating artery (PCOM) IA and a left A1 IA in a 70-year-old woman.
- Discussion of open, endovascular, and hybrid treatment options considered during multidisciplinary review.
- Selection and execution of a single-stage, right-sided open approach for clipping both aneurysms through one craniotomy.
Main Results:
- The single-stage open approach was successfully completed without complications.
- Postoperative imaging confirmed complete occlusion of both intracranial aneurysms.
- The patient experienced no adverse sequelae from the surgical intervention.
Conclusions:
- Single-stage open clipping of surgically accessible bilateral intracranial aneurysms is a viable and effective treatment.
- This approach can minimize the number of procedures and avoid the need for dual antiplatelet therapy.
- Careful patient selection is crucial for optimizing outcomes in simultaneous bilateral IA clipping.
