Contralateral approach to a carotid bifurcation aneurysm in a case of multiple intracranial aneurysms: a case report

BACKGROUND: Traditionally, surgery of the anterior circulation aneurysms of the cerebral vasculature is dictated by the site of the lesion, excluding such midline lesions as anterior communication artery aneurysms. Few reports address the issue of using a single craniotomy to obliterate multiple aneurysms located in both hemispheres. CASE PRESENTATION: A 51 year-old Caucasian right handed housewife lady (weight 61 kg, height 159 cm) presented with a headache of acute onset which proved to be caused by acute subarachnoid hemorrhage. Cerebral computed tomographic angiography revealed multiple aneurysms. The patient underwent a right pterional craniotomy to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms. The post-operative course was uneventful. CONCLUSION: Despite technical difficulties of approaching cerebral vasculature through a contralateral craniotomy, this policy is advised in selected cases in which the benefits of unilateral craniotomy outweigh the risks of brain retraction.