Abstract
Objective: We report the case of a large unruptured paraclinoid aneurysm treated by preoperative embolization of the ophthalmic artery and proximal occlusion of the parent internal carotid artery performed during external carotid-middle cerebral artery bypass surgery.
Case presentation: A 72-year-old woman presented with a transient loss of consciousness. Three-dimensional angiograms revealed a large paraclinoid aneurysm extending to the cavernous sinus. The supraclinoid carotid artery was compressed by the aneurysm and was displaced medially under the optic nerve. The ophthalmic artery, in this case, originated from the cavernous segment of the internal carotid artery (i.e., the dorsal ophthalmic artery). After balloon test occlusion of the ophthalmic artery, its origin was occluded with two detachable coils. Four days later, the cervical portion of the internal carotid artery was ligated during external carotid-middle cerebral artery bypass surgery. The aneurysm was no longer apparent in both intra- and post-operative angiography.
Conclusion: Our therapy needs no manipulation of the supraclinoid carotid artery and the optic nerve, avoiding visual impairment by surgery, and may be a good alternative treatment strategy when large or giant paraclinoid aneurysms extend to the cavernous sinus.
