• Can Xin, Zhengwei Li, Jianjian Zhang, Zhongwei Xiong, Xiaolin Wu, Shiyu Zhao, Mingjun Cai, Wenyuan Zhao, and Jincao Chen.
• Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, People's Republic of China.
• World Neurosurg. 2018 Aug 1; 116: 383-386.

BackgroundAlthough clipping and coiling of intracranial aneurysms are effective treatment options, they each have limitations. With the advent of the hybrid operating room, combined clipping and coiling for complex aneurysms in one stage becomes feasible. We report a successful case of a left posterior communicating artery aneurysm where combined clipping and endovascular treatment were applied.Case DescriptionA 57-year-old man had been complaining of severe headache for 10 days. The computed tomography scan from a previous hospital revealed a parasellar lesion, and the computed tomography angiography in our hospital showed a 16-mm posterior communicating artery aneurysm. Clipping of the aneurysm was scheduled in our hybrid operating room, which enabled intervention of intraoperative digital subtraction angiography (DSA). However, once the aneurysm was clipped, intraoperative DSA revealed that the aneurysm was remnant. We readjusted the clip and reran DSA, but the residual neck was still present. In an effort to preserve the parent artery and perforators, we decided to perform endovascular treatment. Coiling was achieved, followed by angiography, indicating that the aneurysm was almost eliminated. Overall, the patient underwent 4 angiographic explorations during surgery.ConclusionsCombined open surgical and endovascular approaches to treat complex cerebral aneurysms in an hybrid operating room could offer an alternative when the aneurysms appear unclipped or remnant intraoperatively. In our experience, simultaneous clipping and coiling is a safe and effective procedure for efficient treatment of aneurysms.Copyright © 2018 Elsevier Inc. All rights reserved.

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