Technical Feasibility of the Endoscopic Endonasal Approach for Clipping an Ophthalmic Artery Aneurysm With an Origin Lateral to the Optic Nerve: A Case Report.

Ophthalmic artery aneurysms (OAAs) present a challenge for microsurgical clip ligation given their close proximity to critical structures. Endovascular management of OAAs is usually the preferred treatment option; however, the risk of recurrence remains a concern. OAAs have previously been clipped via an endoscopic endonasal approach (EEA). To our knowledge, this is the first report exploring the technical feasibility of EEA for clipping an OAA with an origin lateral to the optic nerve and reviewing the literature on all cerebral aneurysms (CAs) clipped via an EEA. This is a case report of a 36-year-old female with an unruptured left OAA measuring 7 × 7 mm with a 4 mm neck lateral to the optic nerve. She also had a right 2 × 3 mm OAA. Given her young age and bilateral OAAs, we opted for clip ligation of the left OAA to avoid placement of bilateral flow-diverter stents. After extensive discussion with the patient, she underwent successful clip ligation of the left OAA via an expanded EEA approach. In well-selected cases, EEA provides a safe and direct corridor for clipping OAAs with an origin lateral to the optic nerve.