Superior Orbital Rim Approach for Anterior Communicating Artery Aneurysms: A Surgical Series of 27 Patients

Jeon, Byung Chan; Chen, Si Yuan; Zheng, Yong Ri; Cho, Yong Woon; Kwon, Ki Young

doi:10.3346/jkms.2003.18.4.566

Cited by 5 publications

(10 citation statements)

References 30 publications

(22 reference statements)

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“…A wide variety of approaches to the AComm region have been described,[79151820232533–3537384145–47] and our description of the subfrontal approach only differs from other reports in subtle ways, but these subtleties have made big differences in our practice. All of the approaches provide appropriate exposure and achieve satisfactory results.…”

Section: Discussionmentioning

confidence: 97%

Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients

Petraglia

Srinivasan²,

Moravan³

et al. 2011

Surg Neurol Int

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Background:The pterional approach is the most common for AComm aneurysms, but we present a unilateral approach to a midline region for addressing the AComm complex. The pure subfrontal approach eliminates the lateral anatomic dissection requirements without sacrificing exposure. The subfrontal approach is not favored in the US compared to Asia and Europe. We describe our experience with the subfrontal approach for AComm aneurysms treated at a single institution.Methods:We identified 28 patients treated for AComm aneurysms through the subfrontal approach. Patient records and imaging studies were reviewed. Demographics and case data, as well as clinical outcome at 6 weeks and 1 year were collected.Results:Mean patient age was 48 (range 21–75) years and 64% suffered subarachnoid hemorrhage (SAH). All aneurysms were successfully clipped. Gyrus rectus was resected in 57% of cases, more commonly in ruptured cases. Intraoperative rupture occurred in 11% of cases. The average operative time was 171 minutes. There were two patient deaths. Ninety-two percent of patients had a Glasgow Outcome Scale (GOS) of 5 at 6 weeks. All unruptured patients had a GOS of 5. At 12 months, 96% of all patients had a GOS of 5.Conclusions:The subfrontal approach provides an efficient avenue to the AComm region, which reduces opening and closing friction but still yields a comprehensive operative window for access to the anterior communicating region.

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Section: Discussionmentioning

confidence: 97%

Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients

Petraglia

Srinivasan²,

Moravan³

et al. 2011

Surg Neurol Int

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“…Including the orbital rim in the bone flap would allow approaching the sellar, parasellar and retrosellar areas from further inferiorly and anteriorly [10][11][12][13]. Therefore the MLSO could have the advantage to relatively minimize brain retraction compared to the supraorbital approach, lateral supraorbital approach and pterional approach.…”

Section: Discussionmentioning

confidence: 99%

“…In a study analyzing 9488 aneurym surgeries, IOR occurred at a frequency of 10.09% in the pterional group and 5.78% in the suprabrow group, but considering the group of 3039 ruptured aneurysms, it occurred in 13.8% of the pterional group, and 19.37% of the suprabrow group [16]. In a study focusing only on ruptured aneurysms, IOR occurred in the pterional group at 6%-34.9%, and in the suprabrow group at 0-26% [11,[17][18][19][20][21][22][23][24][25][26]. In an analysis comparing the supraorbital keyhole approach (10.6%) and the pterional approach (2.5%) directly, the supraorbital group showed higher IOR frequency [8].…”

Section: Figure 4 (A and B)mentioning

confidence: 99%

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

Lim¹,

Cho²

2017

Arch Med

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Objectives: Upto now, most authors reported the supraorbital approach for unruptured aneurysm and small and less complex aneurysm. The authors devised the Modified Lateral Supraorbital (MLSO) approach. We present a 16 year experience with MLSO approach for ruptured anterior circulation aneurysms and some parts of posterior circulation aneurysms. Materials and Methods:Aneurysm clipping surgery through the MLSO approach was performed on a total 323 patients. Baseline demographics, operative time, procedural complications, and clinical outcomes at 6 months and 1 year were retrospectively analyzed.Results: For patients treated MLSO approach, 293 had single aneurysms and 30 had multiple aneurysms. The proportion of small, medium, large, and giant aneurysms were 64% (206/323), 31% (101/323), 4.7% (15/323), and 0.3% (1/323). Mean operation time was 219.6 minutes. Procedural complications occurred in 21 cases (6.5%). Five patients died from severe brain swelling and refusal of additional treatment, while 1 patient died from tonsilar herniation due to lumbar catheter drainage. Favorable clinical outcomes, Glasgow Outcome Scale IV or V, were observed in 82.6% (267/293) and 83.6% (270/293) at 6 months and one year follow-up.The MLSO approach has the following advantages: less brain retraction, good surgical field for high positioned A-com or basilar tip aneurysm surgery, short operation time, small skin incision, minimizing temporal muscle manipulation and good cosmetic appearance. Conclusions:The MLSO approach can be considered as a useful approach for neurosurgeons for cases of general ruptured aneurysm, except those with a large amount of intracerebral hemorrhage and severe brain swelling.

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“…Especially the frontalis branch of the facial nerve can be affected through this approaches' techniques (1, 5,9,11,18).…”

Section: █ Conclusionmentioning

confidence: 99%

“…That includes the reduced safety of retraction of the frontal lobe through a widestretched preparation of the sylvian fissure, MCA dissection trauma and broad bone removal with low satisfying cosmetic outcome (17). Another complication could be that the frontalis branch of the facial nerve can be affected through orbitotomy approaches (1, 5,9,11,18). There are also disadvantages There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery.…”

Section: █ Introductionmentioning

confidence: 99%

A modified minipterional (subfrontal-suprapterional) approach to the mca bifurcation with minimal dissection of the temporal muscle.

Petridis

Jung²,

Cheko³

et al. 2016

Turkish Neurosurgery

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There are a number of different surgical approaches in middle cerebral artery (MCA) aneurysm surgery. Evolution from the classical pterional approach towards smaller modified approaches took place over the years. In the present report, we describe a new modified approach in the treatment of MCA aneurysms, which is almost exclusively subfrontal. A modified approach was used on three patients with MCA bifurcation aneurysms. Craniotomy was subfrontal and suprapterional with minimal dissection of the temporal muscle and no drilling of the pterion. In all three cases, after establishing proximal control and dissecting the M1 carefully, retraction of the frontal lobe elevated the sylvian fissure and allowed opening of the fissure. The aneurysm could be identified easily and clips were applied. There was no infection and complete aneurysm clipping was achieved in all 3 patients. The described minimal craniotomy to the MCA through a subfrontal-suprapterional approach allows dissection of peripheral MCA bifurcation aneurysms without any problems.

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Superior Orbital Rim Approach for Anterior Communicating Artery Aneurysms: A Surgical Series of 27 Patients

Cited by 5 publications

References 30 publications

Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients

Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients

A 16 Year Experience with Modified Lateral Supraorbital Approach for Ruptured Cerebral Aneurysms

A modified minipterional (subfrontal-suprapterional) approach to the mca bifurcation with minimal dissection of the temporal muscle.

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