While the pterional approach is one of the most used approaches, there are variations. We have practiced the distal sylvian approach by dissection between the superficial sylvian veins. To evaluate the appropriateness and rationale of this approach, we investigated the microsurgical anatomy of the superficial sylvian vein and the frontal and temporal bridging veins.
Of 76 consecutive patients with a cerebral aneurysm clipped by the distal sylvian approach, significantly more had a frontal bridging vein (79%) than a temporal bridging vein (54%; p＜0.01). The superficial sylvian vein tended to influx into the main trunk of the frontal side rather than the temporal side.
These results show that dissection between the superficial sylvian veins preserves the frontal bridging vein, which has a high prevalence, and dissection of the temporal side of the superficial sylvian veins is more effective.
