We report a case of high-position BA-SCA aneurysm operated by 2 different approaches—pterional and cranio-orbital Dolenc's approach—.
A 48-year-old woman presented with severe headache and vomiting without neurological deficit. CT scan demonstrated subarachnoid hemorrhage localized in the right Sylvian fissure. Cerebral angiogram showed right MCA ruptured and left BA-SCA unruptured aneurysms.
After clipping of the right MCA aneurysm, a left BA-SCA aneurysm was explored by the same pterional approach. However, it was impossible to clip completely because of narrow and deep operative field. Four months later, the same left BA-SCA aneurysm was well explored and clipped successfully by left cranio-orbital Dolenc's approach.
The cranio-orbital craniotomy gives a wide and shallow operative field, and Dolenc's approach gives working space around carotid artery by dissecting the distal ring and the optic canal. For the high-position distal basilar artery aneurysms, there are many reports of approaches such as zygomatic approach and extradural temporo-polar approach to complete clipping safely. The cranio-orbital Dolenc's approach is thought to be useful.
