{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T23:46:28Z","timestamp":1762040788046,"version":"build-2065373602"},"reference-count":79,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Tandem intracranial aneurysms (TandIAs) are rare but inherently complex, and special technical considerations are required for their surgical management. The present case highlights the key surgical aspects of two carotid-ophthalmic TandIAs incidentally found in a 60-year-old female. Both the aneurysms were superiorly projecting, regular in size, and involved the left ophthalmic segment of the internal carotid artery (ICA). The minimum distance between the necks was 3 mm. The patient underwent microsurgery because of the reported major complications rate of the endovascular treatment in the case of a very short minimum distance between the TandIAs. After cervical ICA exposure, both the aneurysms were excluded through a pterional approach. Intradural anterior clinoidectomy and unroofing of the optic canal allowed the mobilization of the left optic nerve. The more distal aneurysm was clipped before the opening of the distal dural ring of the ICA. The proximal aneurysm was clipped with two straight clips stacked perpendicular to the ICA. A small remnant was intentionally left to avoid the stenosis of the ophthalmic artery. Postoperative angiography showed the exclusion of both the aneurysms with a small dog-ear of the more proximal one. The patient was discharged neurologically intact and, after one year, the remnant remained stable. Microsurgical clipping is a definitive and durable treatment for carotid-ophthalmic TandIAs. In the case of a very short minimum distance between the aneurysms, the distal one should be clipped first to make the anterior clinoidectomy, opening of the distal dural ring of the ICA, and clipping of the more proximal aneurysm easier.<\/jats:p>","DOI":"10.3390\/medicina57070731","type":"journal-article","created":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T10:07:37Z","timestamp":1626689257000},"page":"731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Microsurgical Clipping of Carotid-Ophthalmic Tandem Aneurysms: Case Report and Surgical Nuances"],"prefix":"10.3390","volume":"57","author":[{"given":"Matias","family":"Costa","sequence":"first","affiliation":[{"name":"Cerebrovascular Neurosurgery Department, Swedish Neuroscience Institute, Seattle, WA 98122, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mat\u00edas","family":"Baldoncini","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary L.","family":"Tataryn","sequence":"additional","affiliation":[{"name":"Spine Department, Swedish Neuroscience Institute, Seattle, WA 98122, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mickaela Echavarria","family":"Demichelis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agustin","family":"Conde","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3693-5815","authenticated-orcid":false,"given":"Cynthia","family":"Purves","sequence":"additional","affiliation":[{"name":"Division of Interventional Neuroradiology, Juan A. Fernandez Hospital and G\u00fcemes Clinic, Buenos Aires C1425 CABA, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Giotta Lucifero","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juha","family":"Hernesniemi","sequence":"additional","affiliation":[{"name":"Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People\u2019s Hospital, Zhengzhou 450003, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-8528","authenticated-orcid":false,"given":"Sabino","family":"Luzzi","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/BF01400727","article-title":"Multiple intracranial aneurysms: A high risk condition","volume":"118","author":"Vajda","year":"1992","journal-title":"Acta Neurochir."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1227\/00006123-199411000-00001","article-title":"Multiple intracranial aneurysms in a defined population","volume":"35","author":"Rinne","year":"1994","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3171\/jns.1985.63.1.0049","article-title":"Incidence of multiple intracranial aneurysms","volume":"63","year":"1985","journal-title":"J. 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