Surgical Treatment of Internal Carotid Bifurcation and Pericallosal Artery Aneurysms with Unilateral Frontopterionel Skin Incision Technique

Abstract

Aneurysms are one of the primary causes of subarachnoid hemorrhage. Solitary aneurysms are the most commonly seen aneurysms. At the same time multiple aneurysms may be seen. Fifty- five year- old woman who underwent surgery one month ago because of ruptured left internal carotid artery aneurysm was admitted to our hospital for surgical treatment of incidental left internal carotid bifurcation and pericallosal artery aneurysms. During surgical treatment, a modified pterional skin incision was planned starting from contralateral pupilla level at the hair- skin line and extending curvelinearly to the ipsilateral pterional region. This modified craniotomy incision allowed pterional craniotomy and left paramedian craniotomy at the same time. Pterional craniotomy was done at first. Sylvian dissection was performed up to the aneurysmatic dilatation at the location of internal carotid artery bifurcation. Aneurysm was dissected and clipped. Secondly right paramedian frontal craniotomy was performed. Interhemispheric approach was performed for the clipping of the pericallosal aneurysm. In such cases the frontopterional skin incision (a modification of pterional incision) may be used for pterional and paramedian frontal craniotomy.