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.

1. Север И.Н., Герасюта А.Е., Литвиненко Д.В., Ткачев В.В. Классификация аневризм офтальмического сегмента внутренней сонной артерии: обзор литературы. Сеченовский вестник. 2024; 15(4): 4–18. https://doi.org/10.47093/2218-7332.2024.15.4.4-18. EDN: IGGXRN

2. Rahmanian A., Mohammad Hosseini E., Sourani A., et al. Microsurgical treatment of ophthalmic artery aneurysm, a case series of 55 patients with long-term follow-up. BMC Surg. 2024 May; 24(1): 139. https://doi.org/10.1186/s12893-024-02419-x. PMID: 38714953

3. Luzzi S., Del Maestro M., Galzio R. Microneurosurgery for Paraclinoid Aneurysms in the Context of Flow Diverters. Acta Neurochir Suppl. 2021; 132: 47–53. https://doi.org/10.1007/978-3-030-63453-7_7. PMID: 33973028

4. Jani P., Mathuriya S.N., Dhandapani S. Safe Cervical ICA Control for Clipping Clinoid-Ophthalmic Segment ICA Aneurysms. Turk Neurosurg. 2021; 31(5): 821–822. https://doi.org/10.5137/1019-5149.JTN.32688-20.1. PMID: 34169987

5. Ткачев В.В., Литвиненко Д.В., Север И.Н. и др. Патент РФ RU 2 823 205 C1. Способ профилактики и контроля кровотечения из аневризм офтальмического сегмента внутренней сонной артерии. Опубликовано: 22.07.2024 Бюл. № 21.

6. Wascher T.M., Spetzler R.F., Zabramski J.M. Improved transdural exposure and temporary occlusion of the petrous internal carotid artery for cavernous sinus surgery. Technical note. J Neurosurg. 1993 May; 78(5): 834–837. https://doi.org/10.3171/jns.1993.78.5.0834. PMID: 8468617

7. Sekhar L.N., Sen C.N., Jho H.D. Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg. 1990 Jan; 72(1): 35–41. https://doi.org/10.3171/jns.1990.72.1.0035. PMID: 2294182

8. Tawk R.G., Hasan T.F., D’Souza C.E., et al. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clin Proc. 2021 Jul; 96(7): 1970–2000. https://doi.org/10.1016/j.mayocp.2021.01.005. Epub 2021 May 13. PMID: 33992453

9. Silva M.A., See A.P., Dasenbrock H.H., et al. Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis. Neurosurg Focus. 2017 Jun; 42(6): E15. https://doi.org/10.3171/2017.3.FOCUS1718. PMID: 2856598

10. Kanemaru K., Yoshioka H., Hashimoto K., et al. Treatment of Unruptured Large and Giant Paraclinoid Aneurysms in Japan at the Time of Flow Diverter Introduction: A Nationwide, Multicenter Survey by the Japanese Society on Surgery for Cerebral Stroke. World Neurosurg. 2025 Mar; 195: 123571. https://doi.org/10.1016/j.wneu.2024.123571. Epub 2025 Jan 17. PMID: 39681259

11. Behari S., Dikshit P., Singh S., et al. Paraclinoid Segment Aneurysms of the Internal Carotid Artery: Surgical Clipping. Neurol India. 2021 Sep-Oct; 69(5): 1184–1195. https://doi.org/10.4103/0028-3886.329547. PMID: 34747782

12. Babichev K.N., Savello A.V., Svistov D.V., et al. Segmental agenesis of the cervical internal carotid artery with collateral blood supply from the ascending pharyngeal artery and intercavernous anastomosis: a clinical case and literature review. Burdenko’s Journal of Neurosurgery. 2018; 82(2): 81–87. https://doi.org/10.17116/oftalma201882281-87. PMID: 29795090