A temporal transsylvian approach to anterior circulation aneurysms.

Operative management of cerebral aneurysms remains a technically challenging problem in modern neurosurgery despite major advances in microsurgical techniques. This is largely caused by the difficulty of exposing and handling these aneurysms, which are located around the circle of Willis at the base of the brain. Large cranial windows, generous brain retraction, and local brain resection have, at times, been employed to overcome these difficulties. In the present report, an exclusively temporal approach to the anterior aspect of the circle of Willis for surgical treatment of aneurysms arising from the anterior circulation is described. This approach limits the surgical preparation and the craniotomy to the temporal area, protects the temporal branch of the facial nerve from injury, and provides a superior cosmetic appearance soon after surgery. It provides a lateral transsylvian exposure to the base of the brain and thus permits the safe dissection and exposure of the aneurysms using microsurgical techniques with minimal, if any, retraction of the frontal lobe. The need for routine resection of the gyrus rectus for exposure of anterior communicating artery aneurysms is alleviated. This approach can be considered in patients harboring large or small incidental or acutely ruptured anterior circulation aneurysms. The outcome of 96 consecutive patients who underwent this procedure is described to illustrate its safety and effectiveness.