Abstract:Keyhole surgery is partly replacing the standard pterional approach in patients undergoing surgery to treat aneurysms of the anterior circulation. We describe the pterional keyhole approach for the clipping of anterior circulation aneurysms and discuss the efficacy and safety of our keyhole craniotomy procedure. We treated 103 patients with 111 intracranial aneurysms by surgical clipping via the pterional keyhole approach and retrospectively compared the characteristics and clinical outcomes of the keyhole pro… Show more
“…This includes the supraorbital keyhole approach using eyebrow incision4,17). The second is the “trans-sylvian approach”14) that includes the pterional keyhole approach1,18). These so-called “keyhole” surgeries have the advantage of a small wound.…”
Section: Discussionmentioning
confidence: 99%
“…The aim of this approach is to reduce the surgical wound size while maintaining a surgical field that is as wide as possible. However, atrophy of the temporalis muscle can not be resolved6,10,13,18).…”
ObjectiveThe purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach.MethodsBetween June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications.ResultsThe mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was 20.5 mm±10.0 (standard deviation [SD]). The craniotomy size was 1051.6 mm2±206.5 (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case.ConclusionOur STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.
“…This includes the supraorbital keyhole approach using eyebrow incision4,17). The second is the “trans-sylvian approach”14) that includes the pterional keyhole approach1,18). These so-called “keyhole” surgeries have the advantage of a small wound.…”
Section: Discussionmentioning
confidence: 99%
“…The aim of this approach is to reduce the surgical wound size while maintaining a surgical field that is as wide as possible. However, atrophy of the temporalis muscle can not be resolved6,10,13,18).…”
ObjectiveThe purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach.MethodsBetween June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications.ResultsThe mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was 20.5 mm±10.0 (standard deviation [SD]). The craniotomy size was 1051.6 mm2±206.5 (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case.ConclusionOur STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.
“…Perneczky, et al5 introduced the keyhole concept in neurosurgery. Since the keyhole technique is less-invasive and requires small skin incisions and craniotomies and leads to minimal brain exposure, many neurosurgeons have reported the usefulness of modified pterional keyhole approaches 67891011. Hernesniemi, et al7 suggested the use of focused sylvian opening, which is a less-invasive alternative to the classical wide sylvian opening, which is used for the microsurgical management of most MCA aneurysms.…”
PurposeThe purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction (MPR) images for sylvian dissection during microsurgical treatment of middle cerebral artery (MCA) aneurysms.Materials and MethodsForty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MD™ imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings.ResultsUtilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicular images to the sylvian surface in the same orientation as the surgeon's view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs.ConclusionIn addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms.
“…After drilling off the sphenoid wing, the visual angle of microscope will increase by 0-15º, which will maximize the working space without the use of fixed retractors. Second, in order to avoid the use of fixed retractors, widely opening the sylvian fissure to the basal cisterns and adequately releasing CSF should be performed (18,19). Cranial cavity was composed of brain, CSF, and blood supply.…”
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