How I do it: management of M2 tear injury caused by drilling during intradural anterior clinoidectomy for microsurgical clipping of intracranial aneurysms

Background High-speed drilling is associated with potential injury to neurovascular structures, particularly during intradural drilling of the anterior clinoid process. Method During an anterior clinoidectomy, a cotton patty and middle cerebral artery branches became inadvertently wrapped around the bit, causing a tear on the inferior M 2 trunk. Following temporary clipping of the internal carotid artery, the tear was identified. Temporary clips were placed proximally and distally. The tear was then repaired with interrupted microsutures. Conclusion Extreme care should be exercised during clinoidectomy. Should small vascular injury occur, direct microsuturing can be a good alternative to sacrificing or implantation anastomosis repair.