How I do it—Helsinki style mini-pterional craniotomy for clipping of middle cerebral artery bifurcation aneurysms

BACKGROUND: Different versions of the mini-pterional (MPT) approach have been described often with the idea the smaller the better. Attempts to reduce incision and craniotomy size for better cosmetic results should not be performed at the expense of safety. METHOD: We present our take on the MPT as a balance between size and safety which can be adopted by vascular neurosurgeons in training. The craniotomy stays within the confines of the superior temporal line and is completely covered by temporal muscle after closure. CONCLUSION: This approach is cosmetically superior while still offering anatomical familiarity and sufficient instrument maneuverability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-022-05458-6.