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Updated: Feb 18, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Distal transsylvian keyhole approach for unruptured anterior circulation small aneurysms
Ririko Takeda1, Hiroki Kurita2
1Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama, 350-1298, Japan. rtakeda@saitama-med.ac.jp.
Background:
To reduce complications associated with conventional pterional craniotomy, a transsylvian keyhole approach for unruptured small anterior circulation aneurysms is proposed.
Methods:
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.
Conclusions:
This approach permits access to aneurysms via the transsylvian corridor with a smaller area of potential injury of superficial structures.
