A Wide Operative View Without Brain Retractors in a Pterional Approach to an Unruptuted Cerebral Aneurysm

Abstract

We report surgical techniques for gaining a wide operative view without brain retractors in a pterional approach to an unruptured aneurysm. In Summary, the techniques involve: 1) Head positioning with the chin slightly up (vertex down), allowing the frontal lobe to fall away from the orbital roof. 2) Wide arachnoidal dissection using a long strip of Bemsheets serving as brain retractors. 3) Further epidural removal of bone from the sphenoid ridge and the flattening of the orbital roof after gaining the appropriate subdural space. 4) Optic canal unroofing and anterior clinoidectomy resulting in mobilizing the internal carotid artery. A wide operative view without brain retractors contributes to the safe dissection and clipping of an unruptured aneurysm, preserving the parent arteries and their perforators.