The authors have devised a new attractive microsurgical approach for the surgery of anterior communicating aneurysms. It is by frontal median route and is named'unilateral interhemispheric approach'. The advantages of this approach are:
1) Less damage to the frontal lobe and the other intracranial normal structures such as the superior sagittal sinus.
2) Full identification of the aneurysm and the adjacent normal parent arteries.
3) Removal of interhemispheric hematoma which is occasionally found in acute stage but is inaccessible by subfrontal approach, thus preventing the possibility of cerebral vasospasm.
4) Preservation of the olfactory sense.
The disadvantage is, on the other hand, occasional sacrifice of a superior cerebral vein but without evident deficiency by this procedure.
This approach consists of frontal coronal scalp incision, right frontal craniotomy, separation of the right frontal lobe from the left frontal lobe in the interhemispheric fissure and access to aneurysms.
47 patients operated on by this ap% in grade III, 50% in grade IV patients but there was no death in grade I and II patients.
Postoperative mental changes were found in 19.5% of the patients and the right olfactory sense was preserved in 75.6% but the left olfactory sense was preserved in all of the 41 patients examined.
