title: Contralateral mini-craniotomy for clipping of bilateral ophthalmic artery aneurysms using unilateral proximal carotid control and Sugita head frame.
abstract: OBJECTIVE
  Conventional surgical treatment of bilateral ophthalmic aneurysms 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 artery aneurysms were clipped using a unilateral mini-pterional craniotomy and contralateral proximal cervical ICA control while employing the Sugita head frame.
  
  
  METHODS
  A 37-year-old female presented with progressive right retro-orbital headaches. MRI/A revealed a right carotid-ophthalmic aneurysm as well as a small aneurysm on the left carotid-ophthalmic segment. Given the young age and medial orientation of the right aneurysm, 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 aneurysm 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 aneurysm was clipped without optic nerve retraction. After dissection of the distal dural ring and gaining proximal control, the left aneurysm was clipped. Postoperatively, the patient remained intact without any visual complaints, and both aneurysms were obliterated on angiography.
  
  
  CONCLUSIONS
  Our case illustrates safety and control while clipping bilateral ophthalmic artery aneurysms via a unilateral mini-pterional approach and utility of the Sugita head frame.
authors.affiliation: Department of Neurological Surgery, Roosevelt Hospital Center, New York, New York, USA.
authors.forename: Sid
authors.initials: S
authors.lastname: Chandela
authors.forename: Shamik
authors.initials: S
authors.lastname: Chakraborty
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.forename: Allison
authors.initials: A
authors.lastname: Jeddis
authors.forename: Chandranath
authors.initials: C
authors.lastname: Sen
authors.forename: David J
authors.initials: DJ
authors.lastname: Langer
mesh_terms: D000328:Adult; D002343:Carotid Artery, Internal / Q000033:anatomy & histology / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D013525:Surgical Instruments / Q000592:standards; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods