Contralateral mini-craniotomy for clipping of bilateral ophthalmic XXXX using unilateral proximal carotid control and Sugita head frame.

@entity1 @entity227 @entity439 @entity10 @entity438
OBJECTIVE: Conventional surgical treatment of bilateral @entity439 would require bilateral craniotomies and bilateral neck dissections for proximal control of the cervical internal carotid artery (ICA). We present a semiemergent case where bilateral ophthalmic @entity438 were clipped using a unilateral mini-pterional craniotomy and contralateral proximal cervical ICA control while employing the Sugita head frame. CLINICAL PRESENTATION: A 37-year-old female presented with progressive @entity10 . MRI/A revealed a right carotid-ophthalmic @entity439 as well as a small @entity439 on the left carotid-ophthalmic segment. Given the young age and medial orientation of the right @entity439 , direct surgical clipping was planned. It was our thought that a contralateral approach would afford us the best chance to clip the right medially pointing @entity439 fully without optic nerve retraction while having proximal control via exposure of contralateral cervical ICA. METHODS: After gaining proximal ICA control from right neck dissection, the Sugita frame was rotated to allow for a left pterional craniotomy. The right medially pointing ophthalmic @entity439 was clipped without optic nerve retraction. After dissection of the distal dural ring and gaining proximal control, the left @entity439 was clipped. Postoperatively, the @entity1 remained intact without any @entity227 , and both @entity439 were obliterated on angiography. CONCLUSION: Our case illustrates safety and control while clipping bilateral ophthalmic @entity438 via a unilateral mini-pterional approach and utility of the Sugita head frame.
