In reply: clinical and surgical experience with the minipterional craniotomy.

Abstract

We appreciate the comments provided by Figueiredo et al regarding our recent manuscript describing our experience using the minipterional (MPT) craniotomy for select anterior circulation aneurysms.1 As the authors point out in their correspondence, our experience with this technique has been limited to unruptured aneurysms based on the theoretical disadvantage of a limited bony exposure in the setting of cerebral edema associated with subarachnoid hemorrhage. Similarly, we have not attempted the MPT craniotomy for anterior communicating artery aneurysms, in which we felt that a limited bony exposure might require a greater degree of brain retraction. However, Figueiredo and colleagues now report their success using this approach in both subarachnoid hemorrhage and anterior communicating artery aneurysms. We look forward to reading in the future of their clinical experience with these cases, which will surely raise our level of enthusiasm to also attempt these aneurysms through the MPT approach. We are delighted to learn that our work will motivate those who originally described this technique to adopt it for the use of ophthalmic region aneurysms, as we have done. We operated on 22 paraophthalmic region aneurysms through the MPT in our series and there were no instances that the limited exposure comprised our ability to treat these lesions, including the safe performance of anterior clinoidectomy. Figueiredo and colleagues note that they perform postoperative angiography to confirm aneurysm occlusions. At our institution, we routinely perform intraoperative angiography in nearly all cases in which aneurysm clipping is performed.2 There were no instances in which the limited exposure of the MPT compromised our clipping strategy, which was confirmed with intraoperative angiography. We appreciate the kind comments from Figueiredo and colleagues and look forward to reading further reports of this innovative surgical approach as it is adopted by an increasing number of neurosurgeons. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.