Department of Neurological Surgery, Roosevelt Hospital Center, New York, New York, USA.
World Neurosurg. 2011 Jan;75(1):78-82; discussion 41-2. doi: 10.1016/j.wneu.2010.06.028.
Conventional surgical treatment of bilateral ophthalmic aneurysms would require bilateral craniotomies and bilateral neck dissections for proximal control of the cervical internal carotid artery (ICA). We present a semiemergent case where bilateral ophthalmic artery aneurysms were clipped using a unilateral mini-pterional craniotomy and contralateral proximal cervical ICA control while employing the Sugita head frame.
A 37-year-old female presented with progressive right retro-orbital headaches. MRI/A revealed a right carotid-ophthalmic aneurysm as well as a small aneurysm on the left carotid-ophthalmic segment. Given the young age and medial orientation of the right aneurysm, direct surgical clipping was planned. It was our thought that a contralateral approach would afford us the best chance to clip the right medially pointing aneurysm fully without optic nerve retraction while having proximal control via exposure of contralateral cervical ICA.
After gaining proximal ICA control from right neck dissection, the Sugita frame was rotated to allow for a left pterional craniotomy. The right medially pointing ophthalmic aneurysm was clipped without optic nerve retraction. After dissection of the distal dural ring and gaining proximal control, the left aneurysm was clipped. Postoperatively, the patient remained intact without any visual complaints, and both aneurysms were obliterated on angiography.
Our case illustrates safety and control while clipping bilateral ophthalmic artery aneurysms via a unilateral mini-pterional approach and utility of the Sugita head frame.
传统的双侧眶动脉瘤手术需要双侧开颅和双侧颈部解剖，以控制颈内动脉（ICA）近端。我们报告了一个半紧急病例，通过单侧微型翼点开颅术和对侧颈内动脉近端控制，同时使用 Sugita 头架，成功夹闭双侧眼动脉动脉瘤。
一名 37 岁女性出现进行性右侧眼眶后头痛。MRI/A 显示右侧颈内动脉-眼动脉瘤和左侧颈内动脉-眼段小动脉瘤。鉴于右侧动脉瘤的年轻和内侧位置，计划直接手术夹闭。我们认为，对侧入路可以为我们提供最好的机会，在不牵拉视神经的情况下充分夹闭右侧内侧指向的动脉瘤，同时通过暴露对侧颈内动脉获得近端控制。
在右侧颈部解剖获得颈内动脉近端控制后，旋转 Sugita 框架以进行左侧翼点开颅术。未牵拉视神经即夹闭右侧内侧指向的眼动脉瘤。分离远端硬脑膜环并获得近端控制后，夹闭左侧动脉瘤。术后患者保持完整，无任何视力问题，双侧动脉瘤均在血管造影上闭塞。
我们的病例说明了通过单侧微型翼点入路夹闭双侧眼动脉动脉瘤的安全性和控制效果，以及 Sugita 头架的实用性。
