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Updated: Oct 4, 2025

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Complex Intracranial Aneurysms
Shuntaro Togashi1, Hiroaki Shimizu2
1Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Akita, Japan. togashi@med.akita-u.ac.jp.
Abstract:
Complex intracranial aneurysms remain challenging to treat using standard microsurgical or endovascular techniques. These aneurysms often require a combination of deconstructive and reconstructive procedures, such as parent artery occlusion, flow alteration, and blind-alley formation with or without bypass surgery, for effective and enduring therapeutic effects. It is important to determine the type of bypass based on the site of occlusion of the patent artery, anatomical features of the distal vessels, and expected adequate blood flow. In this chapter, we describe the "Standards," "Advances," and "Controversies" in the context of a microsurgical treatment strategy for complex intracranial aneurysms. "Standards" include a combination of frequent and commonly used procedures that have been gathering a certain consensus on their effectiveness. "Advances" include infrequent, demanding, and/or uncertain surgical procedures that are currently under debate. Finally, "Controversies" discuss a number of unsolved issues.
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