Anterior clinoidectomy in low lying internal carotid artery-posterior communicating artery aneurysm

At times, a regulation internal carotid artery-posterior communicating artery junction (ICA-P-Comm) aneurysm becomes a surgical hurdle owing to its close proximity to the anterior clinoid process, an immovable ICA and a concealed dominant P-Comm artery arising from the aneurysm neck.

A 70 year old patient with a low lying ICA-P-Comm aneurysm underwent a “tailored” intradural clinoidectomy for aneurysm clipping.

A tailored anterior clinoidectomy to expose “just enough” allows a proximal ICA control in a suitable area, mobility of an atherosclerotic ICA and exposes the P-Comm artery origin which are essential in safe clipping of these aneurysms.