Craniotomy for Aneurysm

Operative management of cerebral aneurysms remains a technically challenging problem in modern neurosurgery despite major advances in microsurgical techniques. This is largely caused by the difficulty of exposing and handling these aneurysms, which are located around the circle of Willis at the base of the brain. Large cranial windows, generous brain retraction, and local brain resection have, at times, been employed to overcome these difficulties. In the present report, an exclusively temporal approach to the anterior aspect of the circle of Willis for surgical treatment of aneurysms arising from the anterior circulation is described. This approach limits the surgical preparation and the craniotomy to the temporal area, protects the temporal branch of the facial nerve from injury, and provides a superior cosmetic appearance soon after surgery. It provides a lateral transsylvian exposure to the base of the brain and thus permits the safe dissection and exposure of the aneurysms using microsurgical techniques with minimal, if any, retraction of the frontal lobe. The need for routine resection of the gyrus rectus for exposure of anterior communicating artery aneurysms is alleviated. This approach can be considered in patients harboring large or small incidental or acutely ruptured anterior circulation aneurysms. The outcome of 96 consecutive patients who underwent this procedure is described to illustrate its safety and effectiveness.

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The Frontotemporal (Pterional) Approach

Altay¹,

Couldwell²

2012

Neurosurgery

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The frontotemporal, so-called pterional, approach has evolved with the contribution of many neurosurgeons over the past century. It has stood the test of time and has been the most commonly used transcranial approach in neurosurgery. In its current form, drilling the sphenoid wing as far down as the superior orbital fissure with or without the removal of the anterior clinoid, thinning the orbital roof, and opening the Sylvian fissure and basal cisterns are the hallmarks of this approach. Tumoral and vascular lesions involving the sellar/parasellar area, anterior and anterolateral circle of Willis, middle cerebral artery, anterior brainstem, upper basilar artery, insula, basal ganglia, mesial temporal region, anterior cranial fossa, orbit, and optic nerve are within the reach of the frontotemporal approach. In this article, we review the origins, evolution, and modifications of the frontotemporal approach and update the discussion of some of the related derivative procedures.

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Craniotomy for Aneurysm

Cited by 4 publications

References 133 publications

Side selection of pterional approach for anterior communicating artery aneurysms – surgical anatomy and strategy

Side selection of pterional approach for anterior communicating artery aneurysms – surgical anatomy and strategy

A Temporal Transsylvian Approach to Anterior Circulation Aneurysms

The Frontotemporal (Pterional) Approach

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