scholarly journals Modified Supraorbital Keyhole Approach to Anterior Circulation Aneurysms

2016 ◽  
Vol 18 (1) ◽  
pp. 5 ◽  
Author(s):  
Yuhee Kim ◽  
Chan-Jong Yoo ◽  
Cheol Wan Park ◽  
Myeong Jin Kim ◽  
Dae Han Choi ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

Surgical Treatment of Ruptured Anterior Circulation Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 437-442 ◽  
Author(s):  
Nohra Chalouhi ◽  
Pascal Jabbour ◽  
Ibrahim Ibrahim ◽  
Robert M. Starke ◽  
Philippe Younes ◽  
...  
Keyword(s):  
Operative Time ◽  
Anterior Circulation ◽  
Efficient Procedure ◽  
Supraorbital Approach ◽  
Procedural Complications ◽  
Microsurgical Techniques ◽  
One Year ◽  
Keyhole Approach ◽  
Small Aneurysms ◽  
Anterior Circulation Aneurysms

Abstract BACKGROUND: Recent advancements in microsurgical techniques and instrumentation have allowed the development of the keyhole approach in aneurysm surgery. OBJECTIVE: To compare the safety, efficacy, and 1-year clinical outcome of supraorbital keyhole and standard pterional approaches for ruptured anterior circulation aneurysms. METHODS: A total of 87 patients underwent surgical clipping, 40 through the pterional and 47 through the supraorbital keyhole approach. Baseline demographics, operative time, procedural complications, and 1-year patient outcome were retrospectively compared. RESULTS: The 2 groups were comparable with respect to baseline characteristics, with the exception of a higher proportion of small aneurysms (<7 mm) in the supraorbital group (70.2% vs 37.5%, P = .002). Total operative time was significantly shorter in the supraorbital group (205 minutes, P < .001) compared with the pterional group (256 minutes). The rate of procedural complications was lower in patients treated through the pterional (17.5%) vs the supraorbital approach (23.4%, P = .4). Intraoperative aneurysm ruptures occurred more frequently in the supraorbital group (10.6% vs 2.5%). No patient experienced early or late rebleeding in either group. One year after treatment, 75% (30/40) of patients achieved a favorable outcome (Glasgow Outcome Scale IV or V) in the pterional group vs 76.6% (36/47) in the supraorbital group (P = .8). CONCLUSION: The rate of procedural complications may be higher with the supraorbital keyhole approach, but overall patient outcomes appear to be comparable. The pterional approach is a simple, reliable, and efficient procedure. The keyhole approach may be an acceptable alternative for neurosurgeons who have gained sufficient experience with the technique, especially for small noncomplex aneurysms.

A Pterion Keyhole Approach for the Treatment of Anterior Circulation Aneurysms

2006 ◽  
Vol 49 (5) ◽  
pp. 257-262 ◽  
Author(s):  
W.-Y. Cheng ◽  
H.-T. Lee ◽  
M.-H. Sun ◽  
C.-C. Shen
Keyword(s):  
Anterior Circulation ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

scholarly journals How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

2021 ◽  
Author(s):  
Sivashanmugam Dhandapani ◽  
Rajasekhar Narayanan ◽  
Manju Dhandapani ◽  
Hemant Bhagat
Keyword(s):  
Surgical Outcome ◽  
Delayed Cerebral Ischemia ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Lumbar Drain ◽  
Significant Difference ◽  
Keyhole Approach ◽  
Intraoperative Rupture ◽  
Anterior Circulation Aneurysms

Abstract Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

scholarly journals Keyhole Approach for Clipping Anterior Circulation Aneurysms: Clinical Outcomes and Technical Note

2021 ◽  
Vol 8 ◽  
Author(s):  
Dongqi Shao ◽  
Yu Li ◽  
Zhixiang Sun ◽  
Xintao Cai ◽  
Xialin Zheng ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Technical Note ◽  
Lessons Learned ◽  
Long Term Results ◽  
Anterior Circulation ◽  
Invasive Approach ◽  
Postoperative Hematoma ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

Purpose: Keyhole craniotomy is a minimally invasive approach for the treatment of anterior circulation aneurysm. In this study, we evaluated the benefits and value of the keyhole approach by analyzing the surgical results in 235 patients with anterior circulation aneurysm treated by the keyhole approach and identifying lessons learned from addressing various complications in this approach.Patients and Methods: This was a retrospective study in a single institution of 235 surgical patients with 248 anterior circulation aneurysms who had the supraorbital keyhole approach (SKA) or pterional keyhole approach (PKA) between January 2016 and January 2021. The modified Rankin Scale (mRS) was used to measure long-term results during follow up.Results: All 235 patients' aneurysms were fully clamped and have not recurred. Among them, 31 (13.2%) had intraoperative aneurysm rupture, 8 (3.4%) had cerebral vascular spasm, and 4 (1.7%) had intraoperative brain edema. There were seven (3.0%) cases of postoperative infection, eight (3.4%) cases of postoperative cerebral infarction, one (0.4%) case of postoperative hematoma, and two (0.8%) patients had some form of cognitive impairment after surgery. Follow up after surgery demonstrated that 189 out of the 235 patients (80.4%) had favorable outcomes (mRS score 0–2), and 43 (18.3%) had poor outcomes (mRS from 3–5). There were three deaths (1.28%).Conclusions: The keyhole approach has a quick postoperative recovery, a mild postoperative response, and a good surgical outcome. Our findings indicate that the keyhole approach is a safe and effective surgical method for the treatment of anterior circulation aneurysm.

Retractorless Surgery for Anterior Circulation Aneurysms via a Pterional Keyhole Approach

2015 ◽  
Vol 84 (6) ◽  
pp. 1779-1784 ◽  
Author(s):  
Liang-Hong Yu ◽  
Pei-Sen Yao ◽  
Shu-Fa Zheng ◽  
De-Zhi Kang
Keyword(s):  
Anterior Circulation ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms

2014 ◽  
Vol 37 (4) ◽  
pp. 629-636 ◽  
Author(s):  
Hitoshi Yamahata ◽  
Hiroshi Tokimura ◽  
Kenichiro Tajitsu ◽  
Masahiro Tsuchiya ◽  
Ayumi Taniguchi ◽  
...  
Keyword(s):  
Efficacy And Safety ◽  
Anterior Circulation ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

scholarly journals A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

2021 ◽  
Author(s):  
Qing Zhu ◽  
Qing Lan ◽  
Ailin Chen
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Controlled Study ◽  
Endovascular Coiling ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Randomized Controlled ◽  
Microsurgical Clipping ◽  
Keyhole Approach ◽  
Anterior Circulation Aneurysms

Abstract Objective: Few prospective randomized controlled studies have investigated the efficacy of endovascular treatment and microsurgical clipping of intracranial aneurysms, especially via microsurgical keyhole approach. We compared the efficacy of three techniques in treating patients with ruptured anterior circulation aneurysms to provide surgeons with a more objective basis for treatment selection. Methods: 150 patients with ruptured anterior circulation aneurysms were randomly assigned to endovascular treatment, conventional craniotomy, and keyhole approach groups. Aneurysm occlusion, surgical time, hospitalization time, hospitalization expenses, and surgical complications were compared between groups. Results: The complete occlusion rates of aneurysms at discharge were 90% in the endovascular group, 94% in the conventional group, and 96% in the keyhole group. No significant differences in complete occlusion rates or Glasgow Outcome Scale scores were found between groups. In the keyhole approach, conventional craniotomy, and endovascular groups, the overall surgical times were 161.78±34.51 min, 201.55±38.79 min, and 85.86±58.57 min, respectively; the hospitalization times were 11.42±6.64 d, 18.03±7.14 d, and 10.57±8.67 d; hospitalization expenses were 10574.25±4154.25 USD, 13214.54±5487.65 USD, and 20134.58±6587.61 USD; and the incidence rates of postoperative complications such as intracranial infection, cerebral vasospasm, hydrocephalus, intracranial hematoma, and epilepsy were 8%, 28%, and 20%. Conclusions: Endovascular coiling and the microsurgical keyhole approach have the advantages of simple execution, time savings, and short hospitalization. Microsurgical clipping of intracranial aneurysms needs to be updated to a minimally invasive procedure to maintain its complementary value with endovascular treatment.Clinical trial registration: The study has been retrospectively registered in clinicaltrial.org (NCT05049564) in Sep. 8th, 2021.

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