• Sho Tsunoda, Tomohiro Inoue, Masafumi Segawa, and Atsuya Akabane.
• Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan. Electronic address: s.tsunoda1024@gmail.com.
• World Neurosurg. 2021 Nov 1; 155: 13-18.

BackgroundHigh-positioned and/or superoposteriorly directed anterior communicating artery aneurysms can be treated by direct clipping using the pterional (fronto-temporo-sphenoidal) approach. This procedure, however, requires stronger retraction of the frontal lobe. Hence, preservation of the prominent frontal bridging veins (FBVs) draining into the sphenoparietal sinus (SPS) remains a significant challenge in preventing postoperative venous congestion.MethodsWe developed a technique to release the tension on the FBVs by pulling them together with the SPS epidurally. In 2 patients, who had presented with high-positioned and/or superoposteriorly directed anterior communicating artery aneurysms, we peeled off the arachnoid surrounding the FBVs and detached it from the brain surface. We further released the veins by moving them posteriorly, together with the SPS epidurally.ResultsUsing this technique, we established a wide corridor through a more lateral transsylvian trajectory with effective posterior retraction of the frontal lobe and were successful in clipping and obliterating the aneurysms.ConclusionsOpen clipping of unruptured intracranial aneurysms requires accuracy to preserve higher brain function. Our technique was successful in both patients, and preserving the FBVs could be useful in the treatment of such aneurysms.Copyright © 2021 Elsevier Inc. All rights reserved.

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