Surgical Approaches to Intracranial Aneurysms

The decision of which surgical approach to implement to treat an intracranial aneurysm is often difficult and dependent on multiple factors. Regardless of which approach is chosen, the surgeon must first make sure there are optimal conditions within the brain to safely access the aneurysm. The surgeon must ensure that the brain is in a relaxed state for optimal maneuverability and dissection. Significant hydrocephalus should be treated before any craniotomy through external ventricular drainage or a lumbar drainage. In addition, administration of a variety of medicines can reduce brain swelling. Furthermore, the surgeon should aim for both proximal and distal control of the aneurysm to be treated. This can prevent devastating hemorrhage in the event of an intraoperative rupture and serves to soften the aneurysm for optimal clipping. In terms of surgical approach, pterional craniotomy, orbitozygomatic craniotomy, anterior interhemispheric craniotomy, subtemporal craniotomy, far lateral craniotomy, and transpetrous approach all are options in the surgeon’s armamentarium to treat intracranial aneurysms.