Intraoperative Temporal Horn Ventriculostomy for Brain Relaxation During Aneurysm Surgeries in Pterional Approaches

Background: Achieving optimal brain relaxation is paramount in aneurysm surgery. Despite proper positioning and the use of newer anesthetic drugs and the administration of decongestants, it is often not possible to achieve satisfactory relaxation, which can lead to neurological deficits owing to excessive brain retraction. The present study aimed to provide detailed surgical notes regarding the novel technique of temporal horn tapping for intraoperative ventriculostomy. Methods: The hospital records of anterior circulation aneurysm surgery performed during the previous 5 years were retrieved. Only those cases in which we had used temporal horn tapping were included. Ventriculostomy was performed only in those cases in which the brain was tense despite the administration of decongestants. A small corticectomy was performed over the middle temporal gyrus and deepened to access the temporal horn. Results: This technique was used in 84 surgical cases. The mean patient age was 52.8 years. The male/female ratio was 1:1.4. Anterior communicating artery aneurysms were the most common. Adequate brain relaxation was satisfactorily achieved in all cases. Two patients had developed a small temporal hematoma attributable to the temporal corticectomy, both managed conservatively. Conclusions: We believe that this new trajectory through the middle temporal gyrus to access the temporal horn is very safe because of the lack of proximity to any blood vessel or critical structures. We recommend the use of this technique during pterional approaches for acute aneurysmal surgery in the tight, bulging brain to achieve relaxation and avoid secondary complications such as retraction contusions and resultant cerebral edema.