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Superciliary Keyhole Approach for Unruptured Anterior Circulation Aneurysms : Surgical Technique, Indications, and Contraindications

  • Park, Jaechan (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University)
  • Received : 2014.08.08
  • Accepted : 2014.10.05
  • Published : 2014.11.28

Abstract

Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.

Keywords

References

  1. Brydon HL, Akil H, Ushewokunze S, Dhir JS, Taha A, Ahmed A : Supraorbital microcraniotomy for acute aneurysmal subarachnoid haemorrhage : results of first 50 cases. Br J Neurosurg 22 : 40-45, 2008 https://doi.org/10.1080/02688690701601521
  2. Chen L, Tian X, Zhang J, Huang Y, Chen E, Lan Q : Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage : a prospective study at a single institute. Acta Neurochir (Wien) 151 : 781-784; discussion 784, 2009 https://doi.org/10.1007/s00701-009-0205-9
  3. Goh DH, Kim GJ, Park J : Medpor craniotomy gap wedge designed to fill small bone defects along cranial bone flap. J Korean Neurosurg Soc 46 : 195-198, 2009 https://doi.org/10.3340/jkns.2009.46.3.195
  4. Lan Q, Gong Z, Kang D, Zhang H, Qian Z, Chen J, et al. : Microsurgical experience with keyhole operations on intracranial aneurysms. Surg Neurol 66 Suppl 1 : S2-S9, 2006
  5. Mitchell P, Vindlacheruvu RR, Mahmood K, Ashpole RD, Grivas A, Mendelow AD : Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms. Surg Neurol 63 : 47-51; discussion 51, 2005 https://doi.org/10.1016/j.surneu.2004.02.030
  6. Paladino J, Mrak G, Miklić P, Jednacak H, Mihaljević D : The keyhole concept in aneurysm surgery--a comparative study : keyhole versus standard craniotomy. Minim Invasive Neurosurg 48 : 251-258, 2005 https://doi.org/10.1055/s-2005-915599
  7. Park J : Maintenance of cerebral blood flow during microsuture repair of the superior wall of the intracranial internal carotid artery. World Neurosurg 80 : 436.e1-436.e5, 2013
  8. Park J : Self-drilling anchor screws for dural tenting sutures : technical note. Surg Neurol 72 : 175-176, 2009 https://doi.org/10.1016/j.surneu.2008.05.004
  9. Park J, Hwang YH, Kim Y : Extended superciliary approach for middle cerebral artery embolectomy after unsuccessful endovascular recanalization therapy : technical note. Neurosurgery 65 : E1191-E1194; discussion E1194, 2009 https://doi.org/10.1227/01.NEU.0000351783.00831.BB
  10. Park J, Jung TD, Kang DH, Lee SH : Preoperative percutaneous mapping of the frontal branch of the facial nerve to assess the risk of frontalis muscle palsy after a supraorbital keyhole approach. J Neurosurg 118 : 1114-1119, 2013 https://doi.org/10.3171/2013.1.JNS121525
  11. Park J, Kang DH, Chun BY : Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy : maximizing symptomatic resolution and minimizing surgical invasiveness. J Neurosurg 115 : 700-706, 2011 https://doi.org/10.3171/2011.5.JNS102087
  12. Park J, Woo H, Kang DH, Sung JK, Kim Y : Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation. Neurosurgery 68 (2 Suppl Operative) : 300-309; discussion 309, 2011
  13. Ramos-Zuniga R, Velazquez H, Barajas MA, Lopez R, Sanchez E, Trejo S : Trans-supraorbital approach to supratentorial aneurysms. Neurosurgery 51 : 125-130; discussion 130-131, 2002 https://doi.org/10.1097/00006123-200207000-00019
  14. Reisch R, Perneczky A : Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57 (4 Suppl) : 242-255; discussion 242-255, 2005 https://doi.org/10.1227/01.NEU.0000178353.42777.2C
  15. Shin D, Park J : Unruptured supraclinoid internal carotid artery aneurysm surgery : superciliary keyhole approach versus pterional appro-ach. J Korean Neurosurg Soc 52 : 306-311, 2012 https://doi.org/10.3340/jkns.2012.52.4.306
  16. van Lindert E, Perneczky A, Fries G, Pierangeli E : The supraorbital keyhole approach to supratentorial aneurysms : concept and technique. Surg Neurol 49 : 481-489; discussion 489-490, 1998 https://doi.org/10.1016/S0090-3019(96)00539-3

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