Retrograde Suction Decompression "Dallas Technique" and Microsurgical Clipping of Unruptured Large Carotid-Ophthalmic Aneurysm: 2-Dimensional Operative Video

Carotid-ophthalmic aneurysms arise fromthe internal carotid artery distal to the ophthalmic artery1 and account for 5% of all intracranial aneurysms.2 The annual risk of rupture depends on the size and morphology Several treatment options have been described for these aneurysms, including microsurgical clipping, flow diversion, and coil embolization, each with advantages and disadvantages.3-9 The "Dallas Technique" was described originally in 19904 and is currently used less frequently, as endovascular techniques have gained preeminence; yet, its utility remains very high, and we believe it is important for the younger cerebrovascular microsurgeon to remain familiar with it We present the case of a 71-year-old woman who presented with worsening headaches, visual acuity 20/20, and visual fields full to confrontation bilaterally.Imaging revealed a 13-mm left carotid-ophthalmic aneurysm The patient underwent a left pterional craniotomy with retrograde suction decompression "Dallas Technique" and microsurgical clipping of carotid-ophthalmic aneurysm The patient remained neurologically intact with visual acuity 20/20 and visual fields full postoperatively and had obliteration of the aneurysm on postoperative computed tomography angiography The case presentation, surgical anatomy, operative technique and postoperative course, and outcomes are reviewed We demonstrate step-by-step surgical technique and discussion of technical nuances of retrograde suction decompression "Dallas Technique" andmicrosurgical clipping of carotidophthalmic aneurysms with medical artist's rendered illustration The different treatment options for carotid-ophthalmic aneurysms are also reviewed The patient consented to the procedure and to the publication of his/her image. © 2023 Oxford University Press. All rights reserved.