title: Lateral supraorbital approach to ipsilateral PCA-P1 and ICA-PCoA aneurysms.
abstract: BACKGROUND
  Aneurysms of the posterior cerebral artery (PCA) are rare and often associated with anterior circulation aneurysms. The lateral supraorbital approach allows for a very fast and safe approach to the ipsilateral lesions Circle of Willis. A technical note on the successful clip occlusion of two aneurysms in the anterior and posterior Circle of Willis via this less invasive approach has not been published before. The objective of this technical note is to describe the simultaneous microsurgical clip occlusion of an ipsilateral PCA-P1 and an internal carotid artery - posterior communicating artery (ICA-PCoA) aneurysm via the lateral supraorbital approach.
  
  
  METHODS
  The authors present a technical report of successful clip occlusions of ipsilateral located PCA-P1 and ICA-PCoA aneurysms. A 59-year-old female patient was diagnosed with a PCA-P1 and an ipsilateral ICA-PCoA aneurysm by computed tomography angiography (CTA) after an ischemic stroke secondary to a contralateral ICA dissection. The patient underwent microsurgical clipping after a lateral supraorbital craniotomy. The intraoperative indocyanine green (ICG) videoangiography and the postoperative CTA showed a complete occlusion of both aneurysms; the parent vessels (ICA and PCA) were patent. The patient presents postoperative no new neurologic deficit.
  
  
  CONCLUSIONS
  The lateral supraorbital approach is suitable for the simultaneous microsurgical treatment of proximal anterior circulation and ipsilateral proximal PCA aneurysms. Compared to endovascular treatment, direct visual control of brainstem perforators is possible.
authors.affiliation: Department of Neurosurgery, Bergmannstrost Hospital Halle, Halle, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elsharkawy
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.affiliation: Burdenko Neurosurgical Institute, Russian Academy of Medical Sciences, Moscow, Russia.
authors.forename: Oleg
authors.initials: O
authors.lastname: Shekhtman
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Andrade-Barazarte
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Francisco
authors.initials: F
authors.lastname: Munoz
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ferzat
authors.initials: F
authors.lastname: Hijazy
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Makhkam
authors.initials: M
authors.lastname: Makhkamov
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
keywords: Aneurysm; internal carotid artery; lateral supraorbital approach; posterior cerebral artery; posterior communicating artery