title: Horizontal contralateral approach for the distal anterior cerebral artery aneurysm: technical note.
abstract: BACKGROUND
  The authors present a modified interhemispheric approach for the distal ACA aneurysm to resolve several problems including the narrow surgical corridor, the difficulty of proximal control, and the aneurysmal projection toward the surgeon.
  
  
  METHODS
  We refined the positions of the patient's head and the surgeon. The patient's head is fixed with flexion and tilted to the contralateral side. The surgeon sits on the contralateral side of the patient and not on the cranial side.
  
  
  RESULTS
  The present approach allows the surgeon to comfortably use both hands in the horizontal operative filed, to obtain a minimum retraction of the brain, and to easily secure the proximal artery.
  
  
  CONCLUSIONS
  This modified interhemispheric approach is useful for a patient with the distal ACA aneurysm.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. tetuyosi@hsp.md.shinshu-u.ac.jp
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Junpei
authors.initials: J
authors.lastname: Nitta
authors.forename: Fukuo
authors.initials: F
authors.lastname: Nakagawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001921:Brain / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*