The Pterional Approach and Extradural Anterior Clinoidectomy to Clip Paraclinoid Aneurysms
A 46-year-old female presented with an incidental right paraclinoid aneurysm. The 8.66×4.81-mm aneurysm was located at the ophthalmic segment of the ICA, anteriorly and superiorly directed. The preoperative axial T2 MRI scans showed a signal void lesion near the right optic nerve. The images obtained from the digital subtraction angiography of the right carotid artery showed that the saccular aneurysm was directed medial-superiorly and compressed the right optic nerve superolateraly (). The patient experienced dizziness and diplopia. Her visual-field examination showed right inferior quadrantanopia. A decision was thus made to clip the aneurysm through decompression of the optic nerve instead of coil embolization. The 2-dimensional (2D) CT angiography showed that the ACP was an obstacle to clipping the aneurysm (). The aneurysm clipping was finished without complications. The postoperative 2D CT angiography scan shows that the entire ACP was removed, and the aneurysm was clipped with 2 15-mm straight clips (). Her visual field was much improved at an 8 months postoperative exam.\nA 42-year-old female presented with sudden-onset severe headache. The CT scan showed right-frontal-base hemorrhage. The 2D angiography showed that the aneurysm was situated in the site of the hemorrhage. The ACP was an obstacle to clipping the aneurysm (). The 3D CT angiography showed the paraclinoid internal carotid artery aneurysm directed to superolateral side (). A decision was made to clip the aneurysm through hematoma evacuation. The postoperative CT scan showed that the entire ACP was removed, and the aneurysm was clipped with 2 15-mm curved clips ().