Abstract
A left middle cerebral artery aneurysm at the bifurcation (M1-M2 segment) and a right
smaller aneurysm, symmetrical to the previous one were diagnosed in a 69-year-old
female after angiographic exmination for subarachnoid hemorrhage. The preoperative
radiological study did not enable us to identify the bleeding aneurysm so a left supraorbital
keyhole approach was performed to operate on the bigger aneurysm. In the same surgical
session, using the same way of approach, we decided to attack also the right aneurysm
which then revealed itself as being responsible for bleeding. The postoperative angiograms
confirmed the complete exclusion of both aneurysms and the patient was discharged
after good recovery. Although there are remarkable controversies about the surgical
strategies for multiple aneurysms, our experience gives us the opportunity to emphasize
the supraorbital keyhole approach and to reconsider the “timing” of multiple/bilateral
aneurysms.
Key words
Symmetrical aneurysms - exclusion of both aneurysms - keyhole approach
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Dr. N. Martellotta
Department of Neurological Sciences, Neurosurgery
A. Perrino Hospital
72100 Brindisi · Italy
