Turkish Neurosurgery
A modified minipterional (subfrontal-suprapterional) approach to the MCA bifurcation with minimal dissection of the temporal muscle.
Athansios Petridis1, Suzin Jung1
1Sana Kliniken Duisburg, Germany, neurosurgery, Duisburg/ NRW,
DOI: 10.5137/1019-5149.JTN.16472-15.1

Aim:There is a number of different surgical approaches in MCA aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took places over the years. In the present report we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal.Material and Methods:Technical report. On three patients with MCA bifurcation aneurysms a modified approach was used. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion. Results: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. No infections and complete aneurysm clipping was reached in all 3 patients. Conclusion:The described minimal craniotomy to the MCA through a subfrontal-suprapterional approach allows dissection of peripheral MCA bifurcation aneurysms without any problems.

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