One-stage operation with ipsilateral two-piece craniotomies for a case of subarachnoid hemorrhage with multiple intracranial aneurysms

Abstract

Subarachnoid hemorrhage (SAH) with multiple intracranial aneurysms is common, but the difficulties often arise in determining treatment strategy in the acute phase. We experienced a case of SAH with distal anterior cerebral artery aneurysm coexisting with middle cerebral artery and anterior communicating artery aneurysms, in which it was difficult to identify the precise rupture site preoperatively, and both pterional approach and interhemispheric approach were required in the acute phase of SAH. However, we could treat whole aneurysms in one stage and obtained an excellent outcome using our surgical procedure with ipsilateral frontotemporal and frontal parasagittal craniotomies through a single skin incision.

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings – One-stage Surgery with Multiple Craniotomies

“…This study only targeted mUIAs; therefore, caution should be exercised when OSMC are applied to aneurysmal subarachnoid hemorrhage (aSAH) patients with MIAs. Although some studies have reported OSMC in patients with multiple aneurysms and aSAH who underwent emergency surgery [20,28,31], we propose that the use of OSMC should be considered carefully because brain relaxation is di cult. This study is the result of an analysis of the surgeries performed in a single, large-scale, neurovascular center in Korea.…”

“…Multiple intracranial aneurysms (MIAs) account for 7-35% of diagnosed intracranial aneurysms [15,23,26], and have a higher risk of rupture than single intracranial aneurysms [13,31]. Therefore, multiple unruptured intracranial aneurysms (mUIAs) require active treatment.…”

“…If all of the mUIAs cannot be treated with one approach, staged operations should be considered [30,34]. Although it is uncommon, there have been cases in which two or more craniotomy procedures were performed using one incision [5,11,31]. There few studies on bilateral craniotomy, most of which are case reports [6,7,12,20,28].…”

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings—One-Stage Surgery with Multiple Craniotomies

“…Multiple intracranial aneurysms (MIAs) account for 7-35% of diagnosed intracranial aneurysms [15,23,26], and have a higher risk of rupture than single intracranial aneurysms [13,31]. Therefore, multiple unruptured intracranial aneurysms (mUIAs) require active treatment.…”

“…If all of the mUIAs cannot be treated with one approach, staged operations should be considered [30,34]. Although it is uncommon, there have been cases in which two or more craniotomy procedures were performed using one incision [5,11,31]. There few studies on bilateral craniotomy, most of which are case reports [6,7,12,20,28].…”