Turkish Neurosurgery 2017 , Vol 27 , Num 5
A Modified Mini-Pterional (Subfrontal-Suprapterional) Approach to MCA Bifurcation Aneurysms with Minimal Dissection of the Temporal Muscle
Athanasios K. PETRIDIS1,Suzin JUNG1,Azad CHEKO1,Martin SCHOLZ1
1Sana Kliniken Duisburg, Department of Neurosurgery, Duisburg, Germany DOI : 10.5137/1019-5149.JTN.16472-15.1 There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took place over the years. In the present report, we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal.

A modified approach was used on three patients with MCA bifurcation aneurysms. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion. In all three cases, after establishing proximal control and dissecting the M1 carefully, retraction of the frontal lobe elevated the sylvian fissure and allowed opening of the fissure. The aneurysm could be identified easily and clips were applied. There was no infection and complete aneurysm clipping was achieved in all 3 patients.

The described minimal craniotomy to the MCA through a subfrontal-suprapterional approach allows dissection of peripheral MCA bifurcation aneurysms without any problems. Keywords : Pterional approach, Middle cerebral artery aneurysm, Subfrontal approach

Corresponding author : Suzin JUNG, suzin.jung@sana.de