Acta Neurochirurgica

, Volume 161, Issue 3, pp 607–610 | Cite as

Step-wise pterional combined epidural and subdural approach to clip large carotid-ophthalmic segment aneurysms

  • Peng HuEmail author
  • Hong-Qi Zhang
  • Xing-Juan Li
How I Do it - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery - Aneurysm



Microsurgical clipping of large ophthalmic-carotid artery (OA) aneurysms is technically challenging. Among the reported approaches, pterional combined epidural and subdural approach is one of the efficient choices.


We have applied this approach to treat a 33-year old female patient with a left large OA aneurysm. The step-wise technical details of this approach are reported.


We show that it is a safe way to clip large OA aneurysms through a step-wise pterional combined epidural and subdural approach, which could make a clear anatomy and a confident manipulation.


Ophthalmic-carotid artery aneurysm Large Clipping 



Cerebrospinal fluid


Computed tomography


Internal carotid artery


Digital subtracted angiography


Motor evoked potentials


Magnetic resonance imaging


Ophthalmic-carotid artery


Somatosensory evoked potentials



The authors would like to thank Mr. Ming-Chu Li for his nice preparation of cadaveric anatomy pictures.

Funding information

Doctor Peng Hu was sponsored by the National Natural Science Foundation of China (grant number of 81500988). Doctor Peng Hu and Doctor Hong-Qi Zhang were sponsored by the National Key R&D Program of China (grant number 2016YFC1300800). The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been approved by the Local University Hospital Ethics Review Board (Xuanwu Hospital, Capital Medical University).

Informed consent

Written consent form has been obtained from each patient.


  1. 1.
    Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672CrossRefPubMedGoogle Scholar
  2. 2.
    Dolenc VV (1999) A combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain. Acta Neurochir Suppl 72:89–97PubMedGoogle Scholar
  3. 3.
    Hakuba A, Tanaka K, Suzuki T, Nishimura S (1989) A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 71:699–704CrossRefPubMedGoogle Scholar
  4. 4.
    Umansky F, Nathan H (1982) The lateral wall of the cavernous sinus. With special reference to the nerves related to it. J Neurosurg 56:228–234CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.XuanWu HospitalCapital Medical UniversityBeijingChina

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