Aesthetics must be considered in surgery for unruptured cerebral aneurysms, since it is a prophylactic treatment and a good-quality postoperative life should be maintained. We introduce several of our attempts to this end.
To prevent postoperative alopecia, scalp clips are not used, and a skin incision is made perpendicular to the hairline and parallel to the hair-growing angle. Prevention of postoperative atrophy of the temporal muscle is attempted by not using keyholes, not using incision in the anterior part of the muscle, and preserving deep temporal arteries and veins. Any craniotomy lines and burr holes should be covered by artificial devices or autologous bone powder obtained during craniotomy and tightly covered by subgaleal connective tissue or temporal muscle with periosteum.
In bald-headed patients, keyhole surgery is effective to make the scar ambiguous. Otherwise, a craniotomy under a skin incision on a wrinkle of the forehead, which can offer a larger operative field than keyhole surgery, effectively obscures the skin incision postoperatively.
These attempts have resulted in satisfactory aesthetic effects both subjectively and statistically.
