PMC7771409_01
Positioning: the patient is positioned supine, with the neck slightly extended and the head laterally rotated, approximately 30 degrees. The head rotation may be modified by tilting the table, as needed (e.g., a more lateral inclination is needed during partial orbitotomy or anterior clinoidectomy). A curvilinear scalp incision is started 1 cm above the base of the zygomatic arch. It is extended superiorly, about 1 cm behind the hairline, and curved gradually toward the ipsilateral midpupillary line. The superior border of the minipterional craniotomy is the superior temporal line.
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F1
Computed tomography (CT) revealed a nonruptured left parasellar giant intracranial aneurysm (GIA) [Figure 1].
Extradural minipterional approach: the dural incision is shown by the dashed line. First, a linear cut, which follows the axis of the Sylvian fissure and is projected toward the space between the optic nerve and the internal carotid artery, is performed. The second cut is performed anterior to the optic nerve and directed inferiorly, in the direction of the cavernous sinus, followed by the division of the external dural ring. MOB: Meningo-orbital band.
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F2
CT angiography and a digital subtraction cerebral angiogram delineated a 27 mm saccular GIA at the junction of the ICA and posterior communicating cerebral artery [Figure 2].