Double aneurysm clipping of true fetal posterior communicating artery by minipterional approach plus control with sodium fluorescein: a case report

Abstract

Introduction: True fetal or fetal type posterior communicating artery aneurysms (PComA) are a technical challenge for the neurosurgeon in both endovascular and microsurgical treatment. Microsurgical clipping using minimally invasive approaches is a safe and optimal alternative solution. Clinical case: a 53-year-old patient who presented subarachnoid hemorrhage, Hunt & Hess scale III, Fisher scale III, and Glasgow Coma Scale of 13. Cerebral angioCT showed two saccular aneurysms in the right true fetal PComA. The patient underwent a right interfacial minipterional craniotomy and clipping of the 2 aneurysms, using sodium fluorescein as a guide. Total occlusion of the aneurysms was achieved, maintaining the patency of the fetal PComA. Conclusion: The minipterional approach allows adequate access to the fetal PComA and the aneurysms originating from it. It is essential to review the patency of the adjacent vessels, being the use of intraoperative fluorescein is an essential complement to avoid complications such as cerebral infarction. Keywords: Intracranial Aneurysm, Craniotomy, Fluorescein, Subarachnoid Hemorrhage, Neurosurgeons (Source: MeSH NLM)