We describe our modification of the pterional approach to reduce invasiveness of surgical clipping for unruptured cerebral aneurysms, and we assess the less invasiveness and the cosmetic results of this modification. In this modification, the scalp incision was limited to the hair line from the upper origin of auricle to the temporal line. A fascio-cutaneous flap was made, and temporal muscle fibers were divided just on the lesser wing of sphenoid bone. This provided an operative field to make a key burr hole just on the lesser wing of sphenoid bone and a small frontotemporal craniotomy around the anterior sylvian fissure. This modified pterional approach was used for 46 of 127 patients who underwent surgical clipping of unruptured cerebral aneurysms by the pterional route. Successful clipping was accomplished in all patients. This modification reduced blood loss, time required for craniotomy and closure and delayed temporal muscle atrophy.
This modification of pterional craniotomy provides sufficient surgical exposure for clipping of unruptured cerebral aneurysms in anterior circulation with less invasiveness and satisfactory cosmetic results when candidates are selected carefully.
