How I do it—Dolenc approach for clipping of ventral wall paraclinoid ICA aneurysm

Ventral wall ICA aneurysms are a type of Paraclinoid aneurysms which arise from ventral surface of ICA opposite to the origin of the ophthalmic artery. These are technically challenging owing to its close proximity to the anterior clinoid process, difficulty in getting proximal control, difficulty in preserving ophthalmic artery and maintaining the patency of ICA.

A 38 year old patient with a Ventral wall ICA aneurysm by Dolenc approach.

Tailored dural peeling and extradural anterior clinoidectomy exposes proximal part of Paraclinoid ICA allowing better proximal control and a wider exposure, which is crucial for clipping these aneurysms.