Contralateral approach to a carotid bifurcation aneurysm in a case of multiple intracranial aneurysms: a case report
© Tabatabai et al; licensee BioMed Central Ltd. 2009
Received: 04 December 2008
Accepted: 09 January 2009
Published: 09 January 2009
Traditionally, surgery of the anterior circulation aneurysms of the cerebral vasculature is dictated by the site of the lesion, excluding such midline lesions as anterior communication artery aneurysms. Few reports address the issue of using a single craniotomy to obliterate multiple aneurysms located in both hemispheres.
A 51 year-old Caucasian right handed housewife lady (weight 61 kg, height 159 cm) presented with a headache of acute onset which proved to be caused by acute subarachnoid hemorrhage. Cerebral computed tomographic angiography revealed multiple aneurysms. The patient underwent a right pterional craniotomy to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms. The post-operative course was uneventful.
Despite technical difficulties of approaching cerebral vasculature through a contralateral craniotomy, this policy is advised in selected cases in which the benefits of unilateral craniotomy outweigh the risks of brain retraction.
Although controversy exists on the surgical treatment of multiple intracranial aneurysms, some authors advocate surgery of all multiple aneurysms due to the bleeding tendency of these lesions overtime. Successful management of such a malady via a single craniotomy, would be fruitful regarding the morbidity and mortality [1, 2].
Previous studies have addressed the contralateral approach to the anterior circulation aneurysms, yet clarification of the very guidelines regarding microsurgical techniques and neuroanesthetic aspects is still evolving [2–4]. The present case is an example of contralateral pterional craniotomy used to clip an ICA bifurcation saccular aneurysm.
A 51-year-old Caucasian left-handed housewife lady (weight 61 kg, height 159 cm) was admitted to our institution because of severe sudden onset headache followed by transient loss of consciousness and vomiting. On examination she was fully conscious and oriented and complained of severe headache. Nuchal rigidity was evident. No focal neurological deficit was found. Temperature was 38°C and other vital signs were stable. Past medical history was negative and she did not consume any medication.
Clipping of multiple intracranial aneurysms via a single craniotomy could be a safe and reasonable strategy, provided the microsurgical anatomical aspects of individual patients are addressed. Patient selection, dexterity of the surgeon, and fulfillment of neuroanesthetic measures are important factors to be considered in this issue.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Internal Carotid Artery
Middle Cerebral Artery
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