12/22/2025
In this operative video, Dr. Cohen demonstrates the contralateral cross-court approach for clip ligation of a right P1 aneurysm through a left-sided pterional craniotomy.
The basilar artery, its bifurcation, and the contralateral P1 segment are exposed, revealing a perforating vessel arising from the neck of the P1 aneurysm. The cross-court approach is effective in this case, as the anatomy provides favorable visualization for circumferential dissection of the neck. A temporary clip is placed on the basilar trunk to allow controlled manipulation of the neck for definitive clip application. The narrow working space medial to the carotid artery is used to inspect the perforating vessels. A long straight clip is then applied to collapse the aneurysm neck, providing adequate visualization around the blades to preserve the perforators.
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