Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms
A 27-year-old female presented with sudden loss of vision on the left side. Her vision had gradually deteriorated for the past two months. On neuro-ophthalmologic examination, visual acuity measured as 0.1 on the right eye by Snellen's chart, but there was total blindness on the left. There were no defects in visual fields and no limitations in extraocular movement. An aneurysm was measured just over 60 mm in diameter in its greatest dimension (). Preoperative routine BTO was performed during preoperative DSA. Exposure of cervical ICA, intradural and extradural clinoidectomy with resection of DDR was performed routinely via OZA. The non-thrombosed giant aneurysm was directly clipped and the entire length of the supraclinoid ICA was reconstructed with eight different types of fenestrated aneurysm clips. The distal flow through the anterior cerebral artery and middle cerebral artery was nicely preserved (). Postoperatively, the patient experienced right transient hemiparesis two days after surgery. However, it resolved two days later with hypervolemic and hypertensive therapy. Postoperatively, her right eye vision had not changed, but her left eye vision improved to a level that she could perceive hand movement 30 cm in front of her.