The online version of this article (https://doi.org/10.1007/s00701-017-3378-7) contains supplementary material, which is available to authorized users.
• Preemptive analgesia
• Minimal hair-shaving area
• 7-cm linear scalp incision
• No cut and minimal dissection of the temporal muscle
• Preservation of the facial nerve
• Two-burr-hole small craniotomy
• Same microscopic view as the conventional pterional approach
• Same microsurgical procedures as with the conventional pterional approach
• Wide opening of the sylvian fissure
• Making the aneurysm movable enough
To reduce complications associated with conventional pterional craniotomy, a transsylvian keyhole approach for unruptured small anterior circulation aneurysms is proposed.
A 7-cm linear scalp incision is made along the hairline, beginning at the zygoma, followed by minimal temporal muscle dissection. Two burr holes are drilled out at McCarty’s point and the temporal bone, and a 3-cm equilateral triangle bone flap is made, whose apex is located above the sylvian point. After the sphenoid ridge is drilled off, aneurysms are exposed and clipped with conventional microsurgical instruments.
This approach permits access to aneurysms via the transsylvian corridor with a smaller area of potential injury of superficial structures.
The video illustrates the necessary procedures to the pterional keyhole approach for unruptured aneurysmal clipping, showing a left MCA aneurysm as an example. (WMV 114835 kb)
Mori K, Yamamoto T, Oyama K, Watanabe M, Nonaka S, Hara T, Honma K (2008) Lateral supraorbital keyhole approach to clip unruptured anterior communicating artery aneurysm. Minim Invasive Neurosurg 51:291–297 CrossRef
Nathal E, Gomez-Amador JL (2005) Anatomic and surgical basis of the sphenoid ridge keyhole approach for cerebral aneurysms. Neurosurgery 56(1 Suppl):178–185 discussion 178-85 PubMed
- Distal transsylvian keyhole approach for unruptured anterior circulation small aneurysms
- Springer Vienna
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