Volume 51 No 6  Cover Story

The skin incision is usually behind the hair line and did not even go down in front of the ear to the level of zygomatic arch (first low, left). The one layer skin-galea-muscle flap is dislocated after detachment from the bone by periosteal elevator and diathermy, and the flap is retracted anteriorly with spring hooks (first low, right). Only one burr hole is made posteriorly and the bone flap is detached mainly by side-cutting craniotome with the basal part drilled off before lifting the flap (second low, left). The bone flap size is about 3×4 cm (second low, right). The dura mater is opened in a curvilinear incision pointing anterolaterally and elevated with stitches (third low, left). After aneurysm clipping, the bone flap is secured using one skull fixator and two plate and screw systems (third low, right).