Common surgical approaches used in the microsurgical treatment of intracranial aneurysms

Abstract

Despite the recent advances in endovascular therapies for intracranial aneurysms, there remains a sizeable fraction of intracranial aneurysms that should be treated with an open transcranial surgery, either because the aneurysm anatomy is not amenable to endovascular therapy, because the young age of the patient demands the more durable long-term solution provided by surgical clipping, or because the surrounding intracerebral hemorrhage and the resultant mass effect require concurrent surgical decompression. It is more important than ever that during this period of evolution of treatment approaches, neurosurgical practitioners maintain their familiarity with techniques for treating aneurysms surgically. Approximately 3-quarters of aneurysms can be approached and treated using 1 of 4 common surgical approaches: the pterional, orbitozygomatic, far lateral, and anterior interhemispheric approaches. This review focuses on the technical details of these 4 approaches. © 2012 by Lippincott Williams & Wilkins.