Abstract
BackgroundTo reduce complications associated with conventional pterional craniotomy, a transsylvian keyhole approach for unruptured small anterior circulation aneurysms is proposed.MethodsA 7-cm linear scalp incision is made along the hairline, beginning at the zygoma, followed by minimal temporal muscle dissection. Two burr holes are drilled out at McCarty’s point and the temporal bone, and a 3-cm equilateral triangle bone flap is made, whose apex is located above the sylvian point. After the sphenoid ridge is drilled off, aneurysms are exposed and clipped with conventional microsurgical instruments.ConclusionsThis approach permits access to aneurysms via the transsylvian corridor with a smaller area of potential injury of superficial structures.
Highlights
In line with recent advances in endovascular surgery, the need for less invasive direct aneurysm surgery has been increasing
Some types of keyhole approaches have been developed as alternatives to the conventional pterional craniotomy
It is important to understand of the running of a facial nerve for its preservation in this approach
Summary
In line with recent advances in endovascular surgery, the need for less invasive direct aneurysm surgery has been increasing. The incision curves forward, passing 5 cm lateral from the lateral cantus of the eye, and ends at about 7 cm in length inside the hairline (Fig.1a, b) This design of the skin incision contains a sufficient safety margin to avoid facial nerve injury. We can see that this size of craniotomy provides sufficient working space and a familiar view for sharp dissection of the sylvian fissure from the sylvian point to the internal carotid cistern, equal to a conventional large pterional craniotomy (Fig. 2a-d). Acom aneurysms require wide opening of the interhemispheric fissure, so that the conventional pterional approach is better for these aneurysms This technique is contraindicated for patients with ruptured aneurysms, complex aneurysms including large or partially thrombosed aneurysms, and those requiring removal of the anterior clinoid process or bypass
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