Unilateral Approach to Bilateral Clipping of Intracranial Aneurysms: A Case Series

Background Multiple intra-cranial aneurysms whose incidence ranges 7–45% pose significant management issues, often due to the necessity of multiple sequential treatments. We present a consecutive series of patients undergoing unilateral surgical approach to clipping of bilateral intracranial aneurysms and their peri-operative outcome. Methods This is a retrospective case series of ten patients who presented to the National neurosurgical referral center, National academy medical sciences, Nepal between March 2020 and April 2024 with multiple aneurysms. The patients were evaluated and diagnosed based on clinical judgement as well as using CT/MR/DS angiography as imaging modality. Patients admitted with diagnosis of multiple aneurysms, who underwent unilateral approach to bilateral clipping of aneurysms, were included in the study. Results 10 patients underwent unilateral approach to bilateral clipping of intracranial aneurysms. Nine aneurysms were clipped without intra-operative complications, one had mild intra-operative rupture of the ipsilateral aneurysm. The post-operative CT angiography showed obliteration of ipsi- and contralateral aneurysms with no additional morbidity due to prolonged and more extensive dissection. Morphological parameters used to evaluate feasibility of bilateral clipping included limited length of the contralateral A1-M1, size and morphology of the aneurysms, tightness of the subarachnoid space due to hemorrhagic adhesion. Conclusions Contralateral approach is an effective technique to treat bilateral aneurysms with a single surgery, being cost-effective with a reasonable risk profile, provided that a correct preoperative planning is done.