Distal transsylvian keyhole approach for unruptured anterior circulation small aneurysms

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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00701-017-3378-7) contains supplementary material, which is available to authorized users.