Surgical Approaches to Cerebral Aneurysms

Advanced knowledge in surgical neuroanatomy is key in choosing and performing the best possible approach for cerebral aneurysm surgery. Knowledge of cisternal and extradural bony and dural skull base anatomy is of special importance since opening the cisterns and removing the bony skull base are required to provide a wide surgical field, minimize brain retraction, and allow early visualization of the parent artery to enable proximal aneurysm control. The pterional or frontotemporosphenoidal approach, along with its variations and extensions, provides a main route to access anterior circulation aneurysms other than the distal anterior cerebral artery, basilar tip, and proximal superior cerebellar artery aneurysms. Vertebral artery and vertebrobasilar junction aneurysms can be reached with a far lateral approach and distal posterior inferior cerebellar artery aneurysms with the telovelar (trancerebellomedullary fissure) approach.