The Combined Pterionally Interhemispheric Approach as a Solution of Double Aneurysms in the Area of Anterior Communicating Artery and Interhemispheric Hematoma and Hemocephalus

Subarachnoid hemorrhage (SAH) is a life-threatening event with an incidence of six per 100,000 people (for most countries: Finland seems to be an exception with an almost three times higher incidence rate). Case fatality is high, with good outcome in less than half of the patients, despite all efforts to improve the results over the past 30 years. The combined pterionally interhemispheric approach is an approach that is indicated so far very rarely. It is mainly used in the association of an aneurysm on the anterior and middle cerebral arteries, or in the occurrence of two aneurysms of low-liyng anterior connecting artery and distal aneurysm on the anterior cerebral artery. This technique performs around eight cases, four of which are performed associated occurring on the anterior and middle on the lower lying on the anterior connecting artery and distal aneuryms on the anterior cerebral artery. In two cases, including our, their aneurysms projecting in a complex manner. We chose the combined approach due to the location of the aneurysm, due to the deposition of the hematoma interhemispherally above the corpus callosum. Access also allowed a very puncture of the side chamber and its training to a typical place (Kocher's point). When clamping the Yasargil aneurysm with vascular clamps, it allowed a good overview in the area of the necks of the aneurysm and surrounding vascular structures. The basic philosophy for a surgeon is to see all anatomical structures around the aneurysm cerebral arteries together and two on the appearance of associated.[ 1 ]–[ 4 ] Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany