Single frontotemporal approach for microsurgical clipping of bilateral ophthalmic artery aneurysms: a case report

Bilateral ophthalmic aneurysms represent a distinct niche of brain aneurysms located in a complex skull base region. When considering surgical treatment, a single-stage approach is often advantageous to minimize operative time, tissue manipulation, and damage to neural and vascular structures compared to a two-stage surgery. Nonetheless, this procedure is not exempt from risks, given that thorough knowledge, preoperative and intraoperative judgment can be necessary to reduce the significant risk of bilateral vision loss. Thus, a tailored approach often is needed. In this study, we present the case of a 53-year-old female who was diagnosed with bilateral ophthalmic aneurysms during the work-up for chronic headaches. Because of the growth pattern and imminent risk of rupture, she underwent elective microsurgical treatment. A frontotemporal approach ipsilateral to the most lobulated aneurysm was performed. Both aneurysms were successfully clipped in a single craniotomy. Her postoperative imaging demonstrated adequate clipping and an uneventful clinical course. Our case outlines the feasibility of a single approach and contributes to the tailored selection for patients when considering microsurgical treatment for these complex lesions.