{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:00:40Z","timestamp":1786125640719,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Giant paraclinoid aneurysm remains a treatment challenge because of their complex anatomy and surgical difficulties stems frequently from a calcified or atherosclerotic aneurysmal neck and compression of the optic pathways.1\u20139\n                    <jats:sup>-<\/jats:sup>\n                    <jats:sup>9<\/jats:sup>\n                    To improve exposure, facilitate the dissection of the aneurysm, assure vascular control, reduce brain retraction and temporary occlusion time, and enable simultaneous treatment of possible associated aneurysms, we combined the cranio-orbital zygomatic (COZ) approach\n                    <jats:sup>9<\/jats:sup>\n                    with endovascular balloon occlusion of the internal carotid artery (ICA) and suction decompression of the aneurysm.\n                    <jats:sup>4<\/jats:sup>\n                  <\/jats:p>\n                  <jats:p>\n                    The patient is a 50-yr-old female who presented with headache and hemianopsia. MRI, CT, and 4-vessel angiography revealed a giant right ophthalmic paraclinoid partially thrombosed aneurysm. Surgery was performed via right COZ approach with removal of the anterior clinoid. Unroofing the optic canal and opening the falciform ligament and the optic sheath, allowing the dissection and mobilization of the optic nerve from the aneurysm and the origin of ophthalmic artery. The endovascular team placed a deflated, double lumen balloon catheter in the ICA 2 cm above the common carotid bifurcation. Proximal control is achieved by inflating the balloon. Distal control is then gained by temporary clipping just proximal of the origin of PcomA.\n                    <jats:sup>4<\/jats:sup>\n                    Retrograde suction decompression through the catheter partially collapses and softens the aneurysm.\n                    <jats:sup>1<\/jats:sup>\n                    <jats:sup>,<\/jats:sup>\n                    <jats:sup>4<\/jats:sup>\n                    <jats:sup>,<\/jats:sup>\n                    6\u20138\n                    <jats:sup>-<\/jats:sup>\n                    <jats:sup>8<\/jats:sup>\n                    Carotid occlusion was applied twice, 2:47 and 2:57 min. Intraoperative angiogram revealed the obliteration of the aneurysm and the patency of the carotid and ophthalmic artery. The patient recovered well, and visual deficit resolved and was neurologically intact. Patient consented for surgery.\n                  <\/jats:p>\n                  <jats:p>\n                    Illustrations in video reprinted with minimal modification from\n                    <jats:italic toggle=\"yes\">Surgical Neurology<\/jats:italic>\n                    , vol 50, issue 6, Arnautovi\u0107 KI, Al-Mefty O, Angtuaco E, A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneuroysms, 504\u2013518,\n                    <jats:sup>4<\/jats:sup>\n                    Copyright 1998, with permission from Elsevier Science Inc.\n                  <\/jats:p>","DOI":"10.1093\/ons\/opab059","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T02:56:29Z","timestamp":1619751389000},"page":"E424-E425","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["A Combined Microsurgical and Endovascular Approach to Giant Paraclinoid Aneurysm: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"20","author":[{"given":"Mirza","family":"Pojski\u0107","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, Marburg, Germany"},{"name":"Medicinski Fakultet Osijek, Sveu\u010dili\u0161te Josip Juraj Strossmayer, Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenan I","family":"Arnautovi\u0107","sequence":"additional","affiliation":[{"name":"Semmes Murphey Neurologic & Spine Institute, Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-0563","authenticated-orcid":false,"given":"Walid","family":"Ibn Essayed","sequence":"additional","affiliation":[{"name":"Neurosciences Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Neurosciences Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,6]]},"reference":[{"issue":"4","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"567","DOI":"10.3171\/jns.1991.74.4.0567","article-title":"Giant carotid-ophthalmic artery aneurysms: direct clipping utilizing the \u201ctrapping-evacuation\u201d technique","volume":"74","author":"Tamaki","year":"1991","journal-title":"J Neurosurg"},{"issue":"3","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3171\/2017.11.JNS17546","article-title":"The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature","volume":"130","author":"Flores","year":"2018","journal-title":"J Neurosurg"},{"issue":"1","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s10143-012-0415-0","article-title":"Results of microsurgical treatment of paraclinoid carotid aneurysms","volume":"36","author":"Colli","year":"2013","journal-title":"Neurosurg Rev"},{"issue":"6","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S0090-3019(97)80415-6","article-title":"A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms","volume":"50","author":"Arnautovi\u0107","year":"1998","journal-title":"Surg Neurol"},{"issue":"6","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.3171\/2017.7.JNS17673","article-title":"Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 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decompression (RSD) technique: series of 92 patients","volume":"73","author":"Eliava","year":"2010","journal-title":"World Neurosurg"},{"issue":"3","key":"bib9-20251027","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1227\/00006123-198903000-00013","article-title":"An orbitocranial approach to complex aneurysms of the anterior circulation","volume":"24","author":"Smith","year":"1989","journal-title":"Neurosurgery"}],"container-title":["Operative 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