Angiographical Selection of Combined Extra- and Intradural Direct Approach as Operative Approach to Internal Carotid Ophthalmic Aneurysm

A series of 5 patients with a carotid-ophthalmic artery aneurysm were treated surgically. In two patients the aneurysms were large, and two had ruptured. The combined extra- and intradural direct approach seemed to provide a better and safer exposure of the central segment of the internal carotid artery. However, a finding of anterosuperior or superolateral direction of the aneurysm in cerebral angiography indicated danger of rupture of the aneurysm during extradural drilling. In this anatomical situation, intradural removal of the anterior clinoid process makes it safer to state in contact with the wall of aneurysm. In two of the five patients these aneurysms were clipped by removing the anterior clinoid process intradurally. The angiographical direction of the aneurysm dictates the selection of approach for removing the anterior clinoid process and unroofing the optic canal.