Introduction: Minimally invasive neurosurgery is an inexorable tendency. In this sense, the embolization of cerebral aneurysms seems to be the goal to be achieved. However, nowadays, aneurysms of the middle cerebral artery (MCA) has no proper endovascular treatment. Thus , the authors present a minimally invasive alternative for the treatment of aneurysms of the MCA.

Methods: We describe a modification of transpalpebral approach by resection of the sphenoid wing , which provides the possibility of access to aneurysms located in the MCA.

Results: Fifteen patients with incidental MCA aneurysms were submitted to this approach. No patient had any surgical or medical complications . Two patients had the aneurysm rupture during dissection, but were clipped without difficulty . The cosmetical results with 1 year of follow -up demonstrates no visible scars .

Conclusions: The modified transpalpebral approach is a minimally invasive alternative for clipping aneurysms of the middle cerebral artery. Despite technical difficulty for the surgeon , this approach is safe and provides adequate cosmetic results.

Patient Care: Transpalpebral is an minimally invasive alternative for middle cerebral aneurysm clipping.

Learning Objectives: Transpalpebral approach can be an alternative for middle cerebral aneurysm clipping.

References: 1- Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ E. Minimally invasive transpalpebral "eyelid" approach to the anterior cranial base. Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons195-206; discussion 206-7. doi: 10.1227/NEU.0b013e31821c3ea3. PubMed PMID: 21499147. 2- Owusu Boahene KD, Lim M, Chu E, Quinones-Hinojosa A. Transpalpebral orbitofrontal craniotomy: a minimally invasive approach to anterior cranial vault lesions. Skull Base. 2010 Jul;20(4):237-44. doi: 10.1055/s-0030-1249247. PubMed PMID: 21311616; PubMed Central PMCID: PMC3023318.