Abstract
Background:The anterior interhemispheric approach provides wide exposure of the anatomy around the anterior communicating artery aneurysm. A disadvantage of this approach is that splitting the interhemispheric fissure is a complicated surgical maneuver. One solution is to hold the fissure horizontally in the operation field. Surgical procedures for bicoronal scalp incision and craniotomy are difficult in the horizontal head position. We developed a modified low anterior interhemispheric approach to minimize damage to the frontal lobe and olfactory nerve by rotating the head after opening the dura.Methods:The head is fixed in a prerotated Sugita head holder in a neutral head position. Bicoronal scalp incision and frontal craniotomy are performed and the head holder is rotated 30 degrees clockwise to allow gravity to retract the right frontal lobe. The surgeon can then move to the right side of the patient to obtain a horizontal operation field parallel to the interhemispheric fissure.Results:This method was used for 12 patients in the past 6 years. All aneurysms were successfully clipped without any complications related to the procedure. Damage to the frontal lobe was avoided and the olfactory nerve was preserved in all the patients.Conclusion:Intraoperative head rotation minimizes surgical damage to the neural structures in the anterior interhemispheric approach.
Highlights
The anterior interhemispheric approach provides wide exposure of the anatomy around the anterior communicating artery aneurysm
The advantage of the anterior interhemispheric approach is that it provides better visualization of the anterior communicating artery complex and is especially suitable for large, high‐positioned, and posteriorly‐ or superiorly projecting aneurysms.[1,2,8]
The disadvantage of this method is that it is a relatively complicated surgical maneuver to split the interhemispheric fissure compared with the pterional approach
Summary
The anterior interhemispheric approach provides wide exposure of the anatomy around the anterior communicating artery aneurysm. A disadvantage of this approach is that splitting the interhemispheric fissure is a complicated surgical maneuver. One solution is to hold the fissure horizontally in the operation field. Surgical procedures for bicoronal scalp incision and craniotomy are difficult in the horizontal head position. We developed a modified low anterior interhemispheric approach to minimize damage to the frontal lobe and olfactory nerve by rotating the head after opening the dura
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