Microsurgical clipping of aneurysms of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery using of MIPLATTA approach: a video case report

[ 0:03] We present a microsurgical clipping of aneurysms of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery using MIPLATTA approach.

[ 0:14] The patient is a 45-year-old female, presented with complaints of headache for a long time (about 20 years), in occipital and temporal areas, takes paracetamol and nonsteroidal anti-inflammatory drugs for headache relief. Computed tomography angiography of the head was performed. The examination revealed an aneurysm of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery.

[ 0:41] After the skull trepanation, the dura matter was opened. Then a sharp dissection of the superficial Sylvian vein was performed.

[ 0:51] Dissection of the Sylvian fissure.

[ 0:56] Basal cisterns dissection.

[ 01:01] Internal carotid artery dissection. Optic nerve, chiasmatic cistern dissection. Internal carotid artery aneurysm dissection.

[ 01:16] The first step was to begin clipping the middle cerebral artery aneurysm.

Middle cerebral artery dissection. Dissection of the proximal and distal segments of the middle cerebral artery.

[ 01:35] Aneurysm dissection.

[ 01:42] Clipping of the aneurysm neck. In this case, a lap-shaped clip was used to clip the neck of the aneurysm, which allowed complete disconnection of the aneurysm from the blood flow.

[ 01:52] Intra-operative Indocyanine green video-angiography shows that the aneurysm is fully clipped.

[ 02:00] The next step is to clip the aneurysm of the right internal carotid artery.

Sphenoid wing drilling.

[ 02:07] Dissection of the small wing of the sphenoid bone. Removal of the small wing of the sphenoid bone.

[ 02:15] Anterior clinoid process dissection.

[ 02:23] Anterior clinoid process removal.

[ 02:27] Peeling of lateral wall of the cavernous sinus.

[ 02:34] Middle meningeal artery dissection. Middle meningeal artery coagulation and cutting.

[ 02:41] To improve the dissection, a traction of the dura matter of the temporal lobe was performed. [02:49] Dissection of the cavernous segment of the internal carotid artery in the Parkinson’s triangle.

[ 02:54] Trial temporary clipping of the internal carotid artery in the Parkinson’s triangle.

[ 02:59] Distal opening of the dura matter. Optic nerve decompression by excision of the dura matter. [03:06] Dissection of the clinoid segment of the internal carotid artery by excision of the distal dural ring.

[ 03:12] Oculomotor nerve decompression.

[ 03:17] Ophthalmic artery dissection.

[ 03:22] Proximal temporary clipping of the internal carotid artery in the Parkinson’s triangle.

[ 03:27] Distal temporary clipping of the internal carotid artery.

[ 03:30] Application of a permanent curved mini-clip. Removal of temporary clips.

[ 03:36] Intra-operative Indocyanine green video-angiography shows that the aneurysm is fully clipped.

[ 03:43] Post-operative images: Computed tomography angiography of the head was performed.

No signs of neck contrast were detected.

[ 03:54] Thank you for your attention.

The video can be found here: https://rutube.ru/video/private/1ae87cb2c464d4a07d18edd6f90e8597/?p=BoTD4duuPN0wEoYNp4NuMA (RuTube).