PMC4533416_01
Preoperative images. A: Magnetic resonance (MR) angiography indicated a left internal carotid artery (ICA) aneurysm (arrow). B: Left internal carotid angiogram disclosed an ICA-ophthalmic artery aneurysm (arrow). C: Original MR angiography images indicated the aneurysm close to the optic nerve (arrow).
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C). Cerebral angiograms confirmed that the ICA aneurysm originated from the ophthalmic segment, just distal to the origin of the ophthalmic artery, and measured 7 mm (height) with a 3 mm neck (Fig. 1B).
Intraoperative view. A: The aneurysm was through the falciform ligament (arrow). B: After removal of the falciform ligament, the aneurysm penetrated the optic nerve and eroded the roof of the optic canal (arrow). C: After removal of the anterior clinoid process, the neck of the aneurysm was confirmed (arrow). D: After clipping, the aneurysm shrank.
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A reddish part in the falciform ligament covered the optic nerve (Fig. 2A, arrow). After removing the falciform ligament for optic canal unroofing, the tip of the aneurysm penetrated the optic nerve (Fig. 2B, arrow). A part of the anterior clinoid process and the roof of the optic canal were removed carefully by an ultrasonic bone curette (Fig. 2C). The patient underwent successful clipping of the aneurysm, with application of a Yasargil clip under the left optic nerve (Fig. 2D).