Exoscopic Clipping of a Superior Cerebellar Artery Aneurysm via a One-Piece Orbitozygomatic Approach: Educational Operative Video

Superior cerebellar artery (SCA) aneurysms are rare. They represent 1%-2% of all intracranial aneurysms and are usually treated endovascularly.¹ However, when the aneurysm configuration is not optimal for endovascular treatment, microsurgical clipping remains a valid alternative treatment option.²^,³ We present the case of a 66-year-old male patient, with an incidental 7-mm wide-neck SCA aneurysm, with the parent vessel coming directly out of the aneurysm neck (Video 1). The different possible endovascular treatment options were reviewed and deemed not optimal for this specific aneurysm, potentially resulting either in incomplete aneurysm occlusion or vessel occlusion. Microsurgical clipping was considered the most suitable treatment option for this specific aneurysm. Surgery was facilitated by the high-riding localization of the aneurysm, waiving the need for a posterior clinoidectomy to obtain proximal control at the basilar artery. An orbitozygomatic approach was chosen to obtain an optimal caudocranial working angle and reduce the need for brain retraction. This video highlights the thought process in choosing the optimal treatment for this rare type of cerebral aneurysm, and the important surgical steps to safely approach and clip an SCA aneurysm.