Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Navigation-guided K eyhole Approach for Unruptured Intracranial Aneurysms

  • Kil, Jin-Sang (Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University) ;
  • Kim, Dae-Won (Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University) ;
  • Kang, Sung-Don (Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University)
  • Published : 2011.09.30
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Abstract

Objectives : In vascular neurosurgery, the pterional approach has primarily been used in the treatment of a wide variety of diseases. However, there has been an increasing interest in minimally invasive procedures or keyhole approaches for treating cerebral aneurysms. We report our experience with a neuronavigation-guided keyhole approach in the treatments of various intracranial aneurysms. Methods : Between December 2008 and December 2010, 32 patients with unruptured intracranial aneurysms were treated by direct surgical neck clipping through the neuronavigation-guided keyhole approach. A 4 to 5 cm-sized skin incision and a small $2.5{\times}4cm$ craniotomy was performed around the sylvian fissure. The remainder of the aneurysm surgery was performed using conventional microsurgical techniques. Results : The enrolled patients comprised 15 men and 17 women, with a mean age of 63.06 years (range, 47 to 79 years). Of these, 21 aneurysms were in the middle cerebral artery (MCA) bifurcation; 3, in the M1; 5, in the posterior communicating artery segment; 2, in the anterior communicating artery; and 1, in the anterior choroidal artery segment. The size of the aneurysms ranged from 3.5 to 4.8 mm. Mean operation time was 2.19 hours (range, 100 to 150 minutes). All patients were clipped successfully. There were no procedure related complications. Conclusion : We suggest that the navigation-guided keyhole approach is useful for the treatment of anterior circulation aneurysms in selected cases. It has the advantages of less operative time, fewer days of hospitalization, and cosmetic results.

Keywords

References

  1. Al-Mefty O. Supraorbital-pterional approach to skull base lesion. Neurosurgery 21:474-7, 1987 https://doi.org/10.1227/00006123-198710000-00006
  2. Alleyne CH Jr, Barrow DL, Oyesiku NM. Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol 57:380-90, 2002 https://doi.org/10.1016/S0090-3019(02)00705-X
  3. Arnold H, Hermann HD. Skull base chordoma with cavernous sinus involvement. Partial or radical tumour-removal? Acta Neurochir (Wien) 83:31-7, 1986 https://doi.org/10.1007/BF01420505
  4. Carrizo A, Basso A. Current surgical treatment for sphenoorbital meningiomas. Surg Neurol 50:574-8, 1998 https://doi.org/10.1016/S0090-3019(97)00101-8
  5. Czirjak S, Nyary I, Futo J, Szeifert GT. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol 57:314-24, 2002 https://doi.org/10.1016/S0090-3019(02)00698-5
  6. Czirjak S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incisions. Neurosurgery 48:145-50, 2001
  7. Day AL. Aneurysms of the opthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677-91, 1990 https://doi.org/10.3171/jns.1990.72.5.0677
  8. Dolenic VV. A combined transorbital-transclinoid and transsylvian approach to carotid-opthalmic aneurysms without retraction of the brain. Acta Neurochir Suppl (Wien) 72:89-97, 1999
  9. Fukushima T, Miyazaki S, Takusagawa Y, Reichman M. Unilateral interhemispheric keyhole approach for anterior cerebral artery aneurysms. Acta Neurochir Suppl (Wien) 53:42-7, 1991
  10. Grand W, Landi MK, Dare AO. Transorbital keyhole approach to anterior communicating artery aneurysms. Neurosurgery 49:483-4, 2001
  11. Kang SD. Pterional craniotomy without keyhole to supratentorial cerebral aneurysms: technical note. Surg Neurol 60:457-61, 2003 https://doi.org/10.1016/S0090-3019(03)00453-1
  12. Mori K, Osada H, Yamamoto T, Nakao Y, Maeda M. Pterional keyhole approach to middle cerebral artery aneurysms through an outer canthal skin incision. Minim Invasive Neurosurg 50:195-201, 2007 https://doi.org/10.1055/s-2007-985837
  13. Mori K, Yamamoto T, Nakao Y, Oyama K, Esaki T, Watanabe M et al. Lateral supraorbital keyhole approach to clip unruptured anterior communicating artery aneurysms. Minim Invasive Neurosurg 51:292-97, 2008 https://doi.org/10.1055/s-0028-1085422
  14. Nathal E, Gomez-Amador JL. Anatomic and surgical basis of the sphenoid ridge keyhole approach for cerebral aneurysms. Neurosurgery 56:178-85, 2005 https://doi.org/10.1227/01.NEU.0000146209.19341.3B
  15. Paladino J, Mrak G, Miklic P, Jednacak H, Mihalijevic D. The keyhole concept in aneurysm surgery-a comparative study: keyhole versus standard craniotomy. Minim Invasive Neurosurg 48:251-8, 2005 https://doi.org/10.1055/s-2005-915599
  16. Paladino J, Pirker N, Stimac D, Stern-Padovan R. Eyebrow keyhole approach in vascular neurosurgery. Minim Invasive Neurosurg 41:200-3, 1998 https://doi.org/10.1055/s-2008-1052042
  17. Perneczky A, Muller-Forell W, van Lindert E. Keyhole concept in neurosurgery. With endoscope-assisted microsurgery and case studies. ed 1, Stuttgart, Thieme Verlag, 1999, pp 1-272
  18. Ramos-Zuniga R. The trans-supraorbital approach. Minim Invasive Neurosurg 42:133-6, 1999 https://doi.org/10.1055/s-2008-1053385
  19. Schramm J, Kral T, Clusmann H. Transsylvian keyhole functional hemispherectomy. Neurosurgery 49:891-901, 2001
  20. van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 49:481-90, 1998 https://doi.org/10.1016/S0090-3019(96)00539-3
  21. Wilson D. Limited exposure in cerebral surgery. J Neurosurg 34:102-6, 1971 https://doi.org/10.3171/jns.1971.34.1.0102
  22. Yasargil MG, Fox JL. The microsurgical approach to intracranial aneurysms. Surg Neurol 3:7-14, 1975