The Orbitopterional Approach for Large and Giant Middle Cerebral Artery Aneurysms: A Report of Two Cases and Literature Review

Abstract

We report two cases of complex middle cerebral artery aneurysms that were surgically treated using the orbitopterional approach in a two-piece method. The objective of this work is to discuss the usefulness of the orbitopterional approach in the surgical management of large and giant middle cerebral artery aneurysms. A 32-year-old man with a giant aneurysm and a 50-year-old woman with a large and complex aneurysm presented with subarachnoid hemorrhages. Both aneurysms were successfully clipped through an orbitopterional approach. This approach permits a more basal view of the vascular structures with only a minor retraction of frontal lobe. It also increases the view angle and amount of working space available. This approach should be considered as an alternative to the classic pterional craniotomy for the surgical management of such complex lesions.

Intraoperative Functional and Perfusion Monitoring During Surgery for Giant Serpentine Middle Cerebral Artery Aneurysms

“…In order to minimize the risk of new infarction, neuroradiologists embolized only the areas of the aneurysm that were safely distant from the channels potentially feeding the brain parenchyma. A frontotemporal craniotomy was performed (13). Intraoperative motor evoked potentials (MEPs) were monitored continuously.…”

“…Giant aneurysms of the MCA represent 13%e 15% of all giant intracranial aneurysms (7,13). Approximately 4% of the aneurysms located on the MCA are giant and most frequently occur at the bifurcation.…”

25 Skull Base Approaches in Cerebrovascular Surgery

“…1,2 In many cases, anterior communicating artery aneurysms or complex middle cerebral artery aneurysms can be treated best with a skull base approach by minimizing brain retraction and optimizing exposure and maneuverability. [3][4][5][6] Due to the central location in the skull, BCMs are mostly treated by skull base approaches to ensure adequate exposure of the brainstem.…”