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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
A Modified Mini-Pterional (Subfrontal-Suprapterional) Approach to MCA Bifurcation Aneurysms with Minimal Dissection
Athanasios K Petridis1, Suzin Jung, Azad Cheko
1Sana Kliniken Duisburg, Department of Neurosurgery, Duisburg, Germany.
Abstract:
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.
Insights
A new subfrontal surgical approach for middle cerebral artery (MCA) aneurysms offers a minimally invasive option. This technique provides effective aneurysm clipping with no complications in initial patient cases.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Surgical Innovation
Background:
- Surgical treatment of middle cerebral artery (MCA) aneurysms has evolved, moving from traditional pterional approaches to modified, less invasive techniques.
- Minimally invasive surgical strategies aim to reduce patient morbidity while maintaining high efficacy in treating complex cerebrovascular diseases.
Purpose of the Study:
- To introduce and evaluate a novel, predominantly subfrontal surgical approach for treating MCA aneurysms.
- To assess the feasibility, safety, and effectiveness of this modified approach in achieving complete aneurysm clipping.
Main Methods:
- A modified subfrontal-suprapterional craniotomy was performed, minimizing temporal muscle dissection and pterional drilling.
- The surgical technique involved careful proximal control of the M1 segment, frontal lobe retraction to access the sylvian fissure, and direct aneurysm visualization.
- The approach was applied to three patients diagnosed with MCA bifurcation aneurysms.
Main Results:
- Complete aneurysm clipping was successfully achieved in all three patients.
- No intraoperative or postoperative complications, such as infection, were reported.
- The approach facilitated easy identification and clipping of the MCA bifurcation aneurysms.
Conclusions:
- The described minimal subfrontal-suprapterional approach is a safe and effective method for dissecting and treating peripheral MCA bifurcation aneurysms.
- This technique represents a viable alternative to traditional approaches, potentially offering reduced surgical invasiveness for MCA aneurysm treatment.
