title: Low anterior interhemispheric approach--a narrow corridor to aneurysms of the anterior communicating artery.
abstract: BACKGROUND
  Many approaches for clipping anterior communicating artery (ACoA) aneurysms are reported in the literature. We describe here a new approach called "low anterior interhemispheric approach" for clipping of ACoA aneurysms.
  
  
  METHODS
  A low anterior interhemispheric approach utilizing a unilateral frontal craniotomy flap with minimal unilateral frontal lobe retraction was used in treating four patients harboring an unruptured ACoA aneurysm. The approach axis is directed to the ACoA area itself with minimal exposure to the anterior cerebral vessels.
  
  
  RESULTS
  In all patients, complete neck clipping was possible with minimal brain retraction, without vascular damage and preserved olfaction.
  
  
  CONCLUSIONS
  This approach is preferred on anatomical grounds for cases of unruptured small and medium sized ACoA aneurysms projecting anteriorly or posteriorly because the anterior communicating artery complex area can be fully visualized with minimal manipulation of the frontal lobes and anterior cerebral arteries.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: El-Noamany
authors.forename: F
authors.initials: F
authors.lastname: Nakagawa
authors.forename: K
authors.initials: K
authors.lastname: Hongo
authors.forename: Y
authors.initials: Y
authors.lastname: Kakizawa
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed