title: The orbitopterional approach for large and giant middle cerebral artery aneurysms: a report of two cases and literature review.
abstract: We report two cases of complex middle cerebral artery aneurysms that were surgically treated using the orbitopterional approach in a two-piece method. The objective of this work is to discuss the usefulness of the orbitopterional approach in the surgical management of large and giant middle cerebral artery aneurysms. A 32-year-old man with a giant aneurysm and a 50-year-old woman with a large and complex aneurysm presented with subarachnoid hemorrhages. Both aneurysms were successfully clipped through an orbitopterional approach. This approach permits a more basal view of the vascular structures with only a minor retraction of frontal lobe. It also increases the view angle and amount of working space available. This approach should be considered as an alternative to the classic pterional craniotomy for the surgical management of such complex lesions.
authors.affiliation: Division of Neurosurgery, Department of Surgical Specialities, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Alexandre Martins
authors.initials: AM
authors.lastname: Cunha
authors.forename: Guilherme Brasileiro
authors.initials: GB
authors.lastname: Aguiar
authors.forename: Flávio Macheroni
authors.initials: FM
authors.lastname: Carvalho
authors.forename: Elington Lannes
authors.initials: EL
authors.lastname: Simões
authors.forename: José Ricardo
authors.initials: JR
authors.lastname: Pinto
authors.forename: Carlos
authors.initials: C
authors.lastname: Telles