title: Contralateral pterional approach to a giant internal carotid-ophthalmic artery aneruysm: technical case report.
abstract: OBJECTIVE
  The contralateral approach to internal carotid-ophthalmic artery aneurysms has been used in selected cases but has rarely been described for a giant internal carotid artery aneurysm. We report a case of giant aneurysm that was successfully clipped via the contralateral pterional approach.
  
  
  METHODS
  A 69-year-old woman was found to have two aneurysms: a small aneurysm at the left internal carotid-posterior communicating artery and a giant aneurysm at the right internal carotid-ophthalmic artery.
  
  
  METHODS
  A direct clipping operation was performed via the left pterional approach. After the small left internal carotid artery aneurysm was clipped, the contralateral giant aneurysm was further exposed and successfully clipped by use of the same approach via the prechiasmatic space.
  
  
  CONCLUSIONS
  The contralateral pterional approach can be applied even for a giant aneurysm of the carotid-ophthalmic artery aneurysm when the neck of the aneurysm is small and when there is a space between the anterior wall of the aneurysm and the tuberculum sellae. Furthermore, such a giant aneurysm can be clipped more easily and safely via the contralateral approach without compromising visual functions. To our knowledge, this is the first reported case of a giant internal carotid-ophthalmic artery aneurysm approached contralaterally. The feasibility of this approach can be assessed preoperatively by three-dimensional computed tomographic angiography as well as by conventional cerebral angiography.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. khongo@hsp.md.shinshu-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Hongo
authors.forename: N
authors.initials: N
authors.lastname: Watanabe
authors.forename: N
authors.initials: N
authors.lastname: Matsushima
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed