How I do it — focused Sylvian approach for clipping of middle cerebral artery aneurysms

Background The Focused Sylvian Approach (FSA) is a refined, minimally invasive technique for clipping small to medium-sized middle cerebral artery (MCA) aneurysms, prioritizing safety and aesthetics. Method The craniotomy remains confined to the superior temporal line, with the incision concealed within the temporal muscle. The Sylvian fissure is carefully dissected to preserve venous structures. Conclusion FSA achieves optimal vascular control with superior cosmetic outcomes while maintaining adequate exposure for safe aneurysm clipping.