Interhemispheric Approach for Ruptured Anterior Communicating Artery Aneurysms

Abstract

The interhemispheric approach is very useful for the safe and reliable clipping of ruptured anterior communicating aneurysms. This approach enables surgeons to directly visualize the aneurysm and the surrounding vessels, including perforators, and provides a wide surgical corridor for clip insertion from multiple directions. Furthermore, in challenging situations, this approach facilitates vascular reconstruction without the need for graft harvesting. However, because of the procedural difficulty, many young and inexperienced neurosurgeons may hesitate to perform this technique. Therefore, this study aimed to provide useful tips, based on intraoperative photography, for skin and dural incisions, prevention of cerebrospinal fluid leakage and olfactory impairment, and fundamental steps for opening tight interhemispheric fissures. Finally, representative challenging cases that were adequately managed using the advantages of this approach are presented.