Clipping of bilateral MCA aneurysms and a coiled ACOM aneurysm through a modified lateral supraorbital craniotomy

Abstract

We showcase the microsurgical clipping of a left middle cerebral artery (MCA) aneurysm-(B) done through a modifiedright lateral supraorbital craniotomy, as well as clipping of a previously coiled anterior communicating (ACOM) arteryaneurysm-(C) and a bilobed right MCA aneurysm-(A). Splitting of the right sylvian fissure is initially performed followingwhich a subfrontal approach is used to expose and dissect the contralateral sylvian fissure. The left MCA aneurysm isidentified and clipped. The ACOM aneurysm is then clipped following multiple clip repositioning based on flow measurements.The right MCA aneurysm is then identified and each lobe is clipped separately.The first picture showcased in this video is a side to side right and left ICA injection in AP projection. In this picture, (A)points to the bilobed right MCA aneurysm, (B) to the left middle cerebral artery (MCA) aneurysm, and (C) to the previouslycoiled anterior communicating (ACOM) artery aneurysm. The red dotted line shows that both MCA aneurysms liewithin the same plane which makes it easier to clip both of them, through one small craniotomy.