Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.

Mini-orbitozygomatic craniotomy is an alternative to classic approaches and can be assistive in surgery for skull base aneurysms and tumors. Selection of candidates for this keyhole surgery should be based on their critical assessment.

EA is a safe and effective technique providing additional visualization in keyhole surgery of aneurysms.

No abstract

Background: The evolution of skull base approaches associated with individualization of surgical corridor and minimizing the collateral damage. Achieving the radical removal of tumor and preserving the neurological status of the patient is possible, both with the traditional approaches and keyhole approaches. Our work presents experience using the transpalpebral approach (TPA) for microsurgical removal of tuberculum sellae meningioma (TSM). Materials and Methods: A total of 15 patients with meningiomas underwent microsurgical removal of TSM through TPA. Ten patients were women and five were men. The standard preoperative diagnostic protocol includes magnetic resonance imaging with contrast enhancement, brain computed tomography for neuronavigation. We assess surgical complications, functional and cosmetic outcomes, and surgical parameters, including the time of surgery and intraoperative blood loss. Results: Visual impairment was finding in 100% patients, including slight decrease of vision (46,7%, seven patients), partial vision field loss (six patients, 40%), and serious visual impairment (two patients 13.3%). Visual improvement was noted in ten cases (66.7%), there was no improvement in four cases (26.7%), and one case (6.6%) had transient visual worsening for 4 days and slow improvement in 1 month. Headache disappeared in three patients (50%). There were no cases of cerebrospinal fluid leak. Transient frontal hypoesthesia was noted in all patients (100%) without permanent deficit. Transient palsy of the frontal muscle was noted in four patients for 4–6 months. Histological examination revealed WHO Grade I meningioma in 14 cases and in 1 case WHO Grade II meningioma. No deaths were identified in follow-up at 12 months. The average value of the Modified Rankin Scale was 1.4. The mean length of stay in hospital was 5. Conclusion: TPA is technically difficult and requires some experience to work in deep structures in a small surgical corridor. This technique can be good alternative to traditional fronto-lateral, supraorbital keyhole craniotomies, and endoscopic endonasal approaches.

Transpalpebral craniotomy is a safe and effective approach to anterior cranial fossa neoplasms and anterior circle of Willis aneurysms. This approach avoids injury to the frontal and temporal muscles as well as to the facial and trigeminal nerve branches. Patients assessed the postoperative cosmetic result as excellent.

The progress in surgical treatment of intracranial aneurysms is based on the introduction of modern minimally invasive techniques. Among the variety of keyhole approaches, supraorbital craniotomy is most often used in surgical treatment of anterior circle of willis aneurysms. The authors present the preliminary results of application of supraorbital keyhole craniotomy for anterior circle of willis aneurysms in 27 patients. Most of the patients had unruptured aneurysms (18 patients). Nine patients had SAH, and 4 of them were operated on in the acute period. The patients' condition was assessed as a grade 1-2 (Hunt-Hess scale) and grade 1-3 (Fisher scale). There were no intraoperative aneurysm ruptures, other serious complications, and deaths. Postoperative complications were assessed at 2 weeks and 6 months. The postoperative cosmetic outcome was assessed by patients as excellent.

Миниптериональная краниотомия в хирургии аневризм переднего отдела виллизиева круга К.м.н. Р.с. джинджиХАдзе, д.м.н., проф. О.н. дРеВАль, д.м.н., проф. В.А. лАзАРеВ, Р.л. КАмбиеВ ГбОу дПО «Российская медицинская академия последипломного образования» минздрава России, москва, Россия; Гбуз «Городская клиническая больница им. Ф.и. иноземцева» департамента здравоохранения москвы, москва, Россия Одним из значимых событий в хирургии аневризм в свое время стала популяризация микронейрохирургической техники G. yasargil. несмотря на свою универсальность, птериональная краниотомия сопровождается достаточно широкой остео-томией, значительным разрезом кожи и височной мышцы, что может приводить к негативным косметическим эффектам, риску дисфункции височно-нижнечелюстного сустава, повреждению лобной ветви лицевого нерва, онемению кожи лица и головы. нами представлен опыт выполнения миниптериональной краниотомии в хирургии аневризм переднего отдела виллизиева круга у 40 больных. серьезных осложнений или летальных случаев не было. интраоперационных разрывов аневризм также не отмечено. у всех больных наблюдалась ожидаемая транзиторная гипестезия в височной области, что не расценивалось как осложнение, при этом она была значительно меньше, чем при классической птериональной кранио-томии. Послеоперационный косметический результат оценивался пациентами как отличный. One of the significant events in aneurysm surgery was promotion of a microneurosurgical technique by G. yasargil. despite its versatility, pterional craniotomy is associated with extensive osteotomy and a significant incision of the skin and temporal muscle, which may lead to the adverse cosmetic effects, risk of temporomandibular joint dysfunction, injury to the frontal branch of the facial nerve, and facial and scalp numbness. We present our experience with minipterional craniotomy in surgery for anterior circle of Willis aneurysms in 40 patients. there were no serious complications or deaths. Also, there were no intraoperative aneurysm ruptures. All patients had expected transient hypesthesia in the temporal region, which was not considered as a complication. this region was significantly smaller compared to that in classical pterional craniotomy. Patients assessed the postoperative cosmetic outcome as excellent. Ключевые слова: миниптериональная краниотомия, keyhole, минимально инвазивная хирургия, аневризмы. Minipterional craniotomy in surgery for anterior circle of Willis aneurysms