• Yong-Hwan Cho, Myeong-Hun Ha, Tae-Sun Kim, and Sung-Pil Joo.
• Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea.
• World Neurosurg. 2020 Sep 1; 141: 33-36.

BackgroundThe unilateral anterior interhemispheric approach has been widely used for distal anterior cerebral artery (DACA) aneurysms. However, there are some drawbacks of this approach because of the narrow operative field, including possible brain traction injury, bridging vein injury, and inadequate exposure of the aneurysm. Here, we report a case of a DACA aneurysm covered by the falx that could not be totally exposed with the unilateral interhemispheric approach. We successfully obtained a wide view with wedge resection of the falx, avoiding excessive brain traction and division of the superior sagittal sinus.Case DescriptionA 76-year-old woman with a 6-mm unruptured DACA aneurysm underwent a unilateral craniotomy with the anterior interhemispheric approach. In the operative field, the aneurysm was found at the midline, just below the falx. The aneurysm was covered by the falx and could not be completely exposed with the usual brain retraction. Therefore, we performed wedge resection of the falx, thus obtaining sufficient surgical field and totally exposing the aneurysm. We were then able to apply the clip successfully. Postoperative brain computed tomography angiography showed no remnant aneurysm sac or complications of falx resection or brain retraction, such as bleeding or vessel injury.ConclusionsWhen an aneurysm is located just below the falx and is exposed inadequately, performing wedge resection of the falx can expose the aneurysms adequately for application of the clip.Copyright © 2020 Elsevier Inc. All rights reserved.

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