Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Abstract

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.

Comparative Analysis of the Mini-pterional and Supraorbital Keyhole Craniotomies for Unruptured Aneurysms with Numeric Measurements of Their Geometric Configurations

“…The keyhole craniotomy is a novel modification of the PC that allows for use of a minimally invasive approach toward cerebral aneurysms, dramatically minimizes iatrogenic trauma to normal tissues, and still enables complete obliteration of the aneurysm 3)5-8)10)11)14)15). Currently, the mini-pterional keyhole craniotomy (MPKC) and the supraorbital keyhole craniotomy (SOKC) are commonly used 1)5)6)10)11)14)15). However, significant controversy exists with regard to the following questions: is it safe?, is it always possible to reach the target?, is the cosmetic result superior to that of the standard PC from the patient's aspect?, can it be used for treatment of all aneurysms?, and so forth.…”

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

“…The keyhole operation was guaranteed implementation along with the development of endoscopy and navigation technology2,4,16,21,23). In the process of craniotomy, bone window less than 3 cm is called the keyhole which is direct and accurate path and could avoid excess of craniotomy part in routine operation, as far as possible to arrived at the lesion site non-invasively and not exposed no lesion area.…”

Tumors of the anterior skull base

“…This approach does not disturb the temporalis muscle, branches of the facial nerve or the superficial temporal artery, which decreases operative exposure time when compared with a typical bifrontal craniotomy or pterional craniotomy [52,55,56]. An eyebrow incision eliminates the need for a hair shave and is easily hidden by the eyebrow, which decreases the psychological impact of surgery.…”

“…An eyebrow incision eliminates the need for a hair shave and is easily hidden by the eyebrow, which decreases the psychological impact of surgery. Complications associated with the supraorbital approach include transient anesthesia over the frontal part of the scalp or transient frontalis muscle palsy [52,53,55,56]. Less common are cerebrospinal fluid leaks and sinus fistula [55].…”

“…The supraorbital and supraglabellar approaches offer a window to the inferior frontal lobe, to the circle of Willis and dissection of the sylvian fissure without the need of brain retraction [52][53][54]. This approach does not disturb the temporalis muscle, branches of the facial nerve or the superficial temporal artery, which decreases operative exposure time when compared with a typical bifrontal craniotomy or pterional craniotomy [52,55,56].…”