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Objectives : In the treatment of cerebral aneurysms, especially in those unruptured, we should have skills to avoid the development of intraoperative complications. For this purpose, we have developed several surgical tactics within the various surgical approaches. Methods : In the pterional approach, the “modified pterional approach” has been designed wherein the cerebral veins or the olfactory nerve is completely preserved. In the anterior inter-hemispheric approach, we obtain enough surgical space by cutting the superior sagittal sinus and the falx at the anterior part, while preserving all the bridging veins from the frontal lobe. In the transcondylar and fossa approach, there is the so-called “pterional approach in the posterior fossa”, wherein we manipulate the aneurysm through the space lateral to the accessory nerve without using the brain retractor on the brain stem. In the subtemporal approach for a basilar top aneurysm, a pulling out of the tentorial edge toward the outside by a suture is most important and useful, through which we can get enough space proceeding toward the basilar trunk to be temporarily clipped. In the “presigmoid” approach (for example, a right side operation), it is very important to use the suction of the surgeon's left hand through the space between the Vth and VIIth and VIIIth nerves in order not to injure the latter nerves in the case of right-handed surgeons. Results and conclusions : Using our abovementioned surgical tactics, we can operate on our patients without remarkable operative complications. We have especially discussed the modified pterional approach, and the transcondylar and fossa approach. |
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