Skull Base 2010; 20(4): 261-267
DOI: 10.1055/s-0030-1247628

© Thieme Medical Publishers

The Orbitopterional Approach for Large and Giant Middle Cerebral Artery Aneurysms: A Report of Two Cases and Literature Review

Alexandre Martins Cunha1 , Guilherme Brasileiro Aguiar1 , Flávio Macheroni Carvalho1 , Elington Lannes Simões1 , José Ricardo Pinto1 , Carlos Telles1
  • 1Division of Neurosurgery, Department of Surgical Specialities, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
Further Information

Publication History

Publication Date:
27 January 2010 (online)


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.


Alexandre Martins Cunha, M.D. , M.Sc. 

Serviço de Neurocirurgia, Hospital Universitário Pedro Ernesto, UERJ Boulevard Vinte e Oito de Setembro

77, Vila Isabel, Rio de Janeiro–RJ, Brasil CEP: 20551-900