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Updated: Feb 25, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Modified extradural temporopolar approach with suction decompression for clipping of large paraclinoid aneurysm:
Naoki Otani1, Terushige Toyooka1, Kojiro Wada1
1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Background:
Surgical clipping of complicated large paraclinoid aneurysms are still challenging because strong adhesion of aneurysm itself may hinder the dissection of the perforators and the surrounding anatomical structures from the aneurysm dome.
Methods:
We describe 13 consecutive patients and the clipping of complicated, large-sized paraclinoid aneurysms using a modified extradural temporopolar approach combined with retrograde suction decompression and discuss its advantages and pitfalls.
Results:
Modified extradural temporopolar approach with suction decompression (SD) assistance was performed in all patients. There was no complication related to the surgical procedure. Postoperative outcome was good recovery in 7 patients, moderate disability in 4, and severe disability in 2 caused by severe subarachnoid hemorrhage. Favorable outcomes were achieved in 10 patients (84.6%).
Conclusion:
We recommend its less invasive, safe, and useful combined technique in the treatment of symptomatic paraclinoid aneurysms, which carry the risk of neurovascular injury caused by dissection from the aneurysm dome.
