Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions

Czirják, Sándor; Nyáry, István; Futó, Judit; Szeifert, György T.

doi:10.1016/s0090-3019(02)00698-5

Cited by 59 publications

(43 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These techniques and the enormous development of diagnostic facilities permit the treatment of certain intracranial lesions using very small openings. Nowadays, increasing evidence shows that keyhole techniques, if applied properly, are appropriate for the obliteration of intracranial aneurysms 9,10,13,18,21,26,31) . Among the various keyhole procedures, the supraorbital approach is most frequently applied to the treatment of supratentorial aneurysms.…”

Section: Introductionmentioning

confidence: 99%

“…The successful management of supratentorial aneurysms by keyhole supraorbital craniotomy has recently been reported 9,10,13,17,21,24,[26][27][28][29][30][31][32] . However, a remarkable controversy remains regarding the choice between the supraorbital keyhole approach 9,32) , and the pterional approach 12,16) , which is the traditional method for the surgical management of patients with anterior circulation aneurysms. Here, we describe our preliminary experience with the supraor-bital keyhole approach for the clipping of anterior circulation aneurysms and compare it with the traditional pterional approach in terms of patient's subjective outcome assessment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Park

Han

2009

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : Conventional pterional approach is a commonly used neurosurgical technique for the treatment of cerebral aneurysms. However, this technique requires more extensive brain exposure than other key hole approaches and is sometimes associated with surgical traumatization or cosmetic problems. The aim of this study was to compare the postoperative outcome between pterional and supraorbital keyhole approaches in the patients with anterior circulation aneurysms. Methods :The authors reviewed patients with anterior circulation aneurysms who underwent aneurysm clipping via pterional or supraorbital keyhole approach at a single institute over a period of 2 years. Ninety-eight patients harboring 108 aneurysms were included in this study. Various outcomes were recorded, which included clinical grade, cosmetic problems, patients' satisfaction and complications such as chewing discomfort, frontal muscle weakness, hyposmia, infection. Results :The supraorbital approach exhibited a shorter operation time compared with the pterional approach. Complications such as chewing discomfort occurred less frequently in the supraorbital approach group. Moreover, the cosmetic outcome was significantly better in the supraorbital group than in the pterional group. Conclusion : The supraorbital keyhole approach reduced intra-and postoperative complications, including chewing discomfort and cosmetic disturbances, compared with the conventional pterional approach.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Park

Han

2009

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…[5][6][7]9,15,18,19,24,26 Although the operative technique, surgical outcomes, and complications of this approach have been described briefly, to our knowledge patient satisfaction has not yet been reported in the literature.…”

mentioning

confidence: 99%

Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision

Reisch

Marcus

Hugelshofer

et al. 2014

JNS

View full text Add to dashboard Cite

Object The supraorbital approach through an eyebrow incision offers the opportunity to access a wide variety of lesions of the anterior, middle, and even the posterior fossa. The minimally invasive keyhole craniotomy limits brain exploration and retraction and offers the potential for improved surgical outcomes and reduced approach-related complications. Patient satisfaction, however, has not yet been reported in the literature. Methods From January 2002 through December 2011, the lead author (R.R.) used a supraorbital approach through an eyebrow incision for 418 patients with cerebral aneurysms, brain tumors or cystic lesions, and other miscellaneous pathological conditions. For 408 of these patients, a detailed retrospective case note review was conducted to extract data on surgical outcomes and complications, and 375 patients completed a follow-up patient satisfaction questionnaire. Results During the early perioperative period, 8 patients died (overall mortality rate 2.0%). Among patients surveyed, the overall level of satisfaction was high. Patients rated pain from the scar and headache on a scale from 1 to 5 (1 = no pain, 5 = severe pain) as follows: pain was a score of 1 for 289 patients (77.0%), 2 for 46 (12.3%), 3 for 22 (5.9%), 4 for 12 (3.2%), and 5 for 6 (1.6%). Patients also rated cosmetic outcome on a scale from 1 to 5 (1 = very pleasant, 5 = very unpleasant) as follows: outcome was a score of 1 for 315 patients (84.0%), 2 for 33 (8.8%), 3 for 14 (3.7%), 4 for 10 (2.7%), and 5 for 3 (0.8%). Postoperative chewing difficulty was reported for 8 patients (8 [2.1%] temporary, 0 permanent); palsy of the frontal muscle for 21 patients (5.6%; 13 [3.5%] temporary, 8 [2.1%] permanent); frontal hypesthesia for 31 patients (8.3%; 18 [4.8%] temporary, 13 [3.4%] permanent); and hyposmia for 11 patients (2.9%; 3 [0.8%] temporary, 8 [2.1%] permanent). Conclusions The supraorbital approach to the anterior, middle, and posterior fossae through an eyebrow incision offers a favorable rate of approach-associated surgical complications and high patient satisfaction with cosmetic outcome.

show abstract

“…Some authors have reported the usefulness of one-stage clipping of bilateral aneurysms via the supraorbital keyhole approach. 3,6) However, our approach provides the wider working space that is required for aneurysm clipping via the transsylvian approach.…”

Section: Discussionmentioning

confidence: 99%

One-Stage Clipping of Bilateral Middle Cerebral Artery Aneurysms Via the Bilateral Pterional Keyhole Approach

Maruyama

Kurita

Yamaguchi

et al. 2013

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Five patients aged 55 to 73 years (mean 63 years) underwent one-stage clipping for unruptured aneurysms in the bilateral middle cerebral arteries (mean size 4.5 mm, range 2 to 7 mm) via the bilateral pterional keyhole approach in our institute. Important points are as follows: the head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; a 5-cm curvilinear skin incision is made inside the hairline and pterional keyhole craniotomy is made bilaterally using 2 burr holes; the whole operating table is rotated 15 degrees to one side to facilitate the microsurgical trans-sylvian approach and aneurysm clipping; the operating table is rotated to the other side for the contralateral procedure; and particular care is taken to avoid bilateral brain injury. This approach provided minimum but sufficient working space required for trans-sylvian dissection. Aneurysm neck clipping was safely performed in a mean operation time of 5 hours 17 minutes. No complications occurred and satisfactory cosmetic results were obtained in all patients. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimum consequences of brain retraction. One-stage clipping via the pterional keyhole approach is a safe and effective therapeutic option for small bilateral aneurysms.

show abstract

Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions

Cited by 59 publications

References 24 publications

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision

One-Stage Clipping of Bilateral Middle Cerebral Artery Aneurysms Via the Bilateral Pterional Keyhole Approach

Contact Info

Product

Resources

About