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Case Reports
. 2025 Sep 22;17(9):e92957.
doi: 10.7759/cureus.92957. eCollection 2025 Sep.

Temporary Carotid Occlusion Using a Hybrid Microsurgical-Endovascular Approach for Repair of Ophthalmic Artery Aneurysm

Daniel Jaraki  1 , Amber Dorn  1 , Thomas Eckert  1 , Eesha Gurav  1 , Cade Fallow  1 , Nelson Gonzalez  1 , Corey Collins  1 , Roham Moftakhar  2
Affiliations
Case Reports

Temporary Carotid Occlusion Using a Hybrid Microsurgical-Endovascular Approach for Repair of Ophthalmic Artery Aneurysm

Daniel Jaraki et al. Cureus. .

Abstract

A patient in their 50s with a history of anxiety, depression, bipolar disorder, and insomnia presented with two to three weeks of progressive altered mental status, including delusions and hallucinations. Emergency Department workup included non-contrast CT, which disclosed a mass along the anterior midline of the sella. Contrast MRI and computed tomography angiography (CTA) demonstrated a large (17 mm) saccular aneurysm at the para‑ophthalmic segment of the right internal carotid artery, adjacent to the ophthalmic artery origin. In a single hybrid session, the team first performed endovascular balloon‑assisted proximal carotid occlusion, then converted to an external approach via a right frontotemporal craniotomy to clip the aneurysm neck under direct visualization. The patient tolerated the combined endovascular‑microsurgical procedure without intraoperative complications. Postoperatively, they experienced a single seizure on night one but recovered fully after antiepileptic adjustment. Visual acuity improved from 2/200 to 20/100, and the patient was discharged home in stable condition.

Keywords: endovascular surgical repair; hybrid surgery; microsurgical repair; neurosurgery; neurovascular disease; ophthalmic artery aneurysm; vascular surgery.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative axial (a), coronal (b), and sagittal (c) head CT scans.
Masslike abnormality just anterior to the sella near midline measuring 1.4 x 1.0 x 1.4 cm.
Figure 2
Figure 2. Preoperative axial (a), coronal (b), and sagittal (c) cuts of MRI angiogram.
Demonstrating a large right paraophthalmic segment ICA aneurysm (measuring up to 17 mm), which arises at or just distal to the ophthalmic artery takeoff. This projects anterosuperiorly along the planum sphenoidale. ICA: internal carotid artery.
See this image and copyright information in PMC

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