title: Intraoperative head rotation for clipping anterior communicating artery aneurysms.
abstract: BACKGROUND
  The anterior interhemispheric approach provides wide exposure of the anatomy around the anterior communicating artery aneurysm. A disadvantage of this approach is that splitting the interhemispheric fissure is a complicated surgical maneuver. One solution is to hold the fissure horizontally in the operation field. Surgical procedures for bicoronal scalp incision and craniotomy are difficult in the horizontal head position. We developed a modified low anterior interhemispheric approach to minimize damage to the frontal lobe and olfactory nerve by rotating the head after opening the dura.
  
  
  METHODS
  The head is fixed in a prerotated Sugita head holder in a neutral head position. Bicoronal scalp incision and frontal craniotomy are performed and the head holder is rotated 30 degrees clockwise to allow gravity to retract the right frontal lobe. The surgeon can then move to the right side of the patient to obtain a horizontal operation field parallel to the interhemispheric fissure.
  
  
  RESULTS
  This method was used for 12 patients in the past 6 years. All aneurysms were successfully clipped without any complications related to the procedure. Damage to the frontal lobe was avoided and the olfactory nerve was preserved in all the patients.
  
  
  CONCLUSIONS
  Intraoperative head rotation minimizes surgical damage to the neural structures in the anterior interhemispheric approach.
authors.affiliation: Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Oshio
authors.affiliation: Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Onodera
keywords: Anterior communicating artery aneurysm; anterior interhemispheric approach; clipping; head holder