Orbitocranial approach for giant middle cerebral artery bifurcation aneurysms: Is it necessary?

Abstract Background Standard pterional approaches have largely been used as the first option for middle cerebral artery aneurysms. This approach presents several disadvantages when facing giant aneurysms: aneurysmatic neck cannot be adequately seen and perianeurysmatic architecture is not completely visualized, leading to inappropriate clipping techniques. Orbitocranial approaches have been described in anterior communicating aneurysms, but not in middle cerebral artery bifurcation ones. Methods In this report, we present the case of a patient with subarachnoid hemorrhage secondary to a middle cerebral artery bifurcation aneurysm rupture which was clipped using an orbitocranial approach. We describe the surgical technique step-by-step, present a clinical report, and discuss the advantages and utility of this procedure. Results This technique was performed successfully and uneventfully in our patient, and it proved to be a safe method of clipping these kind of aneurysms, providing adequate visualization for the surgeon and making it safer for the patient. Conclusions We consider the orbitocranial approach as an adequate alternative to the conventional pterional approach when facing giant aneurysms of the middle cerebral artery bifurcations as it offers a much better visualization of the aneurysmatic neck, as well as that of the perianeurysmatic architecture.