The dysplastic giant aneurysm with wide neck is a difficult complex aneurysm surgery, the use of endovascular therapy in this pathology is promising and waffle cone technique is very useful in those in wich when we use a Stent and it is impossible to exceed the distal end of the aneurysm neck.

The Subarachnoid Hemorrhage (SAH) is a relatively common disease with an incidence is 5% of cerebral vascular disease. The estimated prevalence of 10 new cases per 100,000 people each year. The proportion of HSA varies with age, being the most prevalent group between 50 and 60. 

Subarachnoid hemorrhage (SAH) is defined as the presence of blood in the subarachnoid space and cisterns of the base. The source is variable and may be due to rupture of intracranial aneurysms (80%), arteriovenous malformations (AVMs), tumors and brain trauma.Treatment should be administered as soon as possible within 72 hours, both surgical and endovascular techniques to prevent complications.

The pterional approach is the most common approach in vascular neurosurgery, but in recent years has been an increasing interest in minimally invasive surgery or keyhole surgery. The authors present preliminary results from the use of pterional keyhole approach in surgery for cerebral aneurysms performed in the Cayetano Heredia Hospital, Peru, in 2009.