A Case of Multiple Anterior Circulation Cerebral Aneurysms Requiring the Modified Craniotomy to Preserve the Middle Meningeal Artery Origin of the Ophthalmic Artery

Abstract

Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, JapanSummary: A 53-year-old woman was referred to our hospital because of multiple unruptured cerebral aneurysms, including right middle cerebral artery, anterior communicating artery, and right paraclinoid internal carotid artery aneurysms. Three-dimensional rotational angiography (3D-RA) revealed the right ophthalmic artery exclusively deriving from the right middle meningeal artery (MMA) and the relationships to the bony anatomy. The morphology of the aneurysms was suitable for microsurgical clipping rather than endovascular coiling. We performed clipping for all the aneurysms via the right frontotemporal craniotomy without resection of the lesser wing of the sphenoid bone and with intradural anterior clinoidectomy to preserve the MMA based on the 3D-RA findings. The patient was discharged from the hospital without visual disturbance. A case of ophthalmic artery originating from the MMA is rare but has a risk of causing visual disturbance due to intraoperative injury of the MMA.Compared with other neuroimaging modalities, 3D-RA is more useful for preoperative evaluation.