THE ANTERIOR INTERHEMISPHERIC TREPHINE APPROACH TO ANTERIOR MIDLINE ANEURYSMS - RESULTS OF TREATMENT IN 72 CONSECUTIVE PATIENTS

We report the results of a prospective study of an anterior interhemispheric trephine approach in 72 consecutive patients with aneurysms of the anterior communicating artery (64 cases) and anterior cerebral arteries (eight cases). The salient features of the operative technique include a limited forehead crease incision, low anterior frontal midline trephine (4 cm), unilateral dural opening (2.5 cm), opening up of the anterior interhemispheric fissure and exposure of aneurysm and anterior cerebral vessels by a phased dissection. The best anatomical orientation is retained without compromising the superior sagittal sinus, falx cerebri, left frontal cortical veins, or eloquent areas of the brain. The results (excellent to good recovery or mild to moderate disability in 87.5% of cases) confirm that the technique is safe and well tolerated even in the elderly or fragile patients.