Exposure of the petrosal segment of the internal carotid artery as a method for preventing intraoperative bleeding during clipping of carotid-ophthalmic aneurysms: a clinical case

Microsurgical treatment of ocular artery aneurysms is classified as high-risk surgery. It is anatomically impossible to prevent and stop bleeding from ophthalmic aneurysms by applying a standard clip proximal to the aneurysm.

Case report. A 46-year-old man was admitted complaining of periodic headaches for 6 months. Outpatient magnetic resonance imaging revealed an aneurysm of the right internal carotid artery (ICA). According to computed tomography and cerebral angiography, an aneurysm of the ocular artery was verified. The patient chose an open surgery from the proposed treatment methods. Clipping of the aneurysm of the ocular artery mouth was performed by pterion access with an extradural extraction of the petrosal segment of the ICA to prevent intraoperative bleeding. The course of the postoperative period was smooth, without neurological symptoms, and the stitches were removed on the 9th day. The patient was discharged under outpatient supervision with a recommendation to control the radicality of clipping after 6 months.

Discussion. Temporary clipping of the ICA in the carotid canal during microsurgical operations for ocular artery aneurysms allows controlling the risk of bleeding from the main surgical access without isolating the neurovascular bundle of the neck, which reduces the traumatic nature of the operation and is preferable from a cosmetic point of view.

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