Trans-Frontal Sinus Approach for Clipping Anterior Communicating Artery Aneurysms in the Subcallosal Region

Objectives: To propose a minimally invasive alternative using an interhemispheric trans-frontal sinus approach for the treatment of high-lying anterior communicating artery (AComA) aneurysms. To describe the technical steps and anatomical considerations of this approach. Methods: Most anterior communicating artery (AComA) aneurysms can be effectively managed through a classic pterional craniotomy. However, aneurysms located in the subcallosal region present greater challenges of access and usually require an interhemispheric route. We describe a minimally invasive variant using an interhemispheric trans-frontal sinus approach. This study includes a review of the surgical anatomy of the frontal sinus and the AComA complex in relation to the subcallosal region. We then detail our operative technique and report outcomes in a series of five patients. Results: The interhemispheric trans-frontal sinus approach provides direct access to the subcallosal region while avoiding an extensive craniotomy, thereby allowing safe clipping of selected AComA aneurysms. Conclusion: The trans-frontal sinus interhemispheric approach offers a minimally invasive alternative for the management of AComA aneurysms located in the subcallosal region. By limiting the need for wide craniotomies, this technique may also improve cosmetic outcomes. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany