# Temporary Carotid Occlusion Using a Hybrid Microsurgical-Endovascular Approach for Repair of Ophthalmic Artery Aneurysm

## TL;DR

A patient with a large brain aneurysm underwent a combined endovascular and microsurgical procedure, resulting in a successful recovery and improved vision.

## Contribution

The paper presents a novel hybrid microsurgical-endovascular approach for ophthalmic artery aneurysm repair.

## Key findings

- The hybrid procedure allowed safe occlusion and clipping of the aneurysm without intraoperative complications.
- The patient's visual acuity improved significantly post-surgery.
- The patient was discharged in stable condition after a brief postoperative seizure.

## Abstract

A patient in their 50s with a history of anxiety, depression, bipolar disorder, and insomnia presented with two to three weeks of progressive altered mental status, including delusions and hallucinations. Emergency Department workup included non-contrast CT, which disclosed a mass along the anterior midline of the sella. Contrast MRI and computed tomography angiography (CTA) demonstrated a large (17 mm) saccular aneurysm at the para‑ophthalmic segment of the right internal carotid artery, adjacent to the ophthalmic artery origin. In a single hybrid session, the team first performed endovascular balloon‑assisted proximal carotid occlusion, then converted to an external approach via a right frontotemporal craniotomy to clip the aneurysm neck under direct visualization. The patient tolerated the combined endovascular‑microsurgical procedure without intraoperative complications. Postoperatively, they experienced a single seizure on night one but recovered fully after antiepileptic adjustment. Visual acuity improved from 2/200 to 20/100, and the patient was discharged home in stable condition.