Non-ruptured large dorsal internal carotid artery aneurysm presenting withtemporal quadrantanopsia

A 63-year-old woman presenting with temporal lower quadrantanopsia of the r ight eye was found to have a large dorsal internal carotid artery aneurysm. Large dorsal aneurysms of the internal carotid artery are rare. Lateral co mpression of the optic nerve by the aneurysm might damage the optic nerve a t the medial side of the right optic foramen. Direct clipping surgery was p erformed uneventfully. Since the dome of the aneurysm was buried in the fro ntal robe and also attached to the anterior skull base, a careful approach to the aneurysm with removal of the anterior clinoid process and drilling i nto the planum sphenoidale around the aneurysm dome was needed. The surgica l strategy is discussed. (C) 2000 Harcourt Publishers Ltd.