Abstract
The surgical approach for 41 cases of carotid-ophthalmic aneurysm is reviewed. These are divided into 4 types according to Kothandaram et al. and Thurél et al.; namely, the subchiasmal type (25 cases), suprachiasmal type (4 cases), parachiasmal type (1 case), and global type (11 cases).
Subchiasmal type aneurysms were mainly treated through the ipsilateral pterional approach removing the anterior clinoid process. However, 8 of the cases did not receive neck clipping for the following reasons: 1) The neck was not visible (4 cases), 2) a part of the aneurysmal dome was located in the cavernous sinus (3 cases), or 3) the neck was not separated from the ophthalmic artery (1 case). The contralateral pterional approach (6 cases) or interhemispheric approach (1 case) was useful in the aneurysm directing medially or posteromedially because the anterior clinoid process need not be removed. Suprachiasmal and parachiasmal type aneurysms were treated through the ipsilateral pterional approach. All 5 aneurysms were clipped successfully, though the anterior clinoid process had to be removed in 4 out of 5 cases. Global type aneurysms were treated by direct attack (4 cases), proximal arterial ligation alone (3 cases), or proximal arterial ligation with extracranial-intracranial (EC-IC) arterial bypass (4 cases). Although direct neck clipping or trapping is ideal for the treatment of global type aneurysms, this procedure was often impossible and proximal arterial ligation with EC-IC bypass was a useful alternative for this type of carotidophthalmic aneurysm.
The surgical approach for carotid-ophthalmic aneurysm should be varied according to the type of aneurysm, position of the neck, and direction of the dome. Those must be clarified prior to surgery by reviewing angiograms and applying high-resolution computed tomography.
