All-around Ultra-small Craniotomy for Cerebral Aneurysm Surgery

Abstract

To minimize operative invasiveness, we propose ultra-small craniotomy for cerebral aneurysm surgery. The size is 4 × 3 cm, which is about twice the size of a 100-yen coin. The sphenoid ridge should be rongeured away to flatten the floor from the frontal base to the temporal pole. For the craniotomy, the sylvian vein is divided into the frontal and temporal lobes in a 2:1 ratio. In skin incision, care should be taken not to injure the facial nerve during division into the frontalis and orbitalis oculi muscles. From the cosmetic viewpoint, the 1- to 2-cm forehead incision used in this technique is not visible. Moreover, this technique can be performed by a beginner neurosurgeon, without any special tool for the procedure.