title: The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients.
abstract: BACKGROUND
  The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap.
  
  
  OBJECTIVE
  To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms.
  
  
  METHODS
  From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap.
  
  
  RESULTS
  The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients.
  
  
  CONCLUSIONS
  The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Caplan
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Papadimitriou
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D010294:Parietal Bone / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult