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Selection Strategy for Optimal Keyhole Approaches for Middle Cerebral Artery Aneurysms: Lateral Supraorbital Versus Minipterional Craniotomy


Esposito, Giuseppe; Dias, Sandra Fernandes; Burkhardt, Jan-Karl; Fierstra, Jorn; Serra, Carlo; Bozinov, Oliver; Regli, Luca (2019). Selection Strategy for Optimal Keyhole Approaches for Middle Cerebral Artery Aneurysms: Lateral Supraorbital Versus Minipterional Craniotomy. World Neurosurgery, 122:e349-e357.

Abstract

BACKGROUND/OBJECTIVE

The lateral supraorbital (LS) and minipterional (MP) approaches have been reported for treating intracranial aneurysms as alternative to the pterional approach. We describe our decision making for selecting the minicraniotomy, LS versus MP, for managing noncomplex aneurysms of the middle cerebral artery (MCA), based on the depth of the aneurysm within the Sylvian fissure.

METHODS

We report on a consecutive case series of 50 patients who underwent clipping of 54 ruptured/unruptured MCA aneurysms by means of LS or MP craniotomies. The distance between the MCA (M1) origin and the aneurysmal neck is key to selection of the approach: LS was used for MCA aneurysms <15 mm from the M1 origin and MP for MCA aneurysms ≥15 mm from the M1 origin.

RESULTS

11 of 50 patients presented with subarachnoid hemorrhage (10 ruptured MCA aneurysms). Overall, 59 aneurysms were successfully clipped (54 of the MCA). The mean distance between the M1 origin and the aneurysmal neck was 10.1 mm (range, 4-17 mm) for patients treated by LS and 20 mm (range, 15-30 mm) for those treated by MP. All but 1 MCA aneurysms were successfully treated. At last follow-up (mean, 14 months), no reperfusion of the clipped aneurysms was observed.

CONCLUSION

Our strategy for selecting the keyhole approach based on the depth of the aneurysm within the Sylvian fissure is efficient and safe. We suggest the use of the LS approach when the aneurysm is <15 mm from the M1 origin and the MP approach when the aneurysm is ≥15 mm from the M1 origin.

Abstract

BACKGROUND/OBJECTIVE

The lateral supraorbital (LS) and minipterional (MP) approaches have been reported for treating intracranial aneurysms as alternative to the pterional approach. We describe our decision making for selecting the minicraniotomy, LS versus MP, for managing noncomplex aneurysms of the middle cerebral artery (MCA), based on the depth of the aneurysm within the Sylvian fissure.

METHODS

We report on a consecutive case series of 50 patients who underwent clipping of 54 ruptured/unruptured MCA aneurysms by means of LS or MP craniotomies. The distance between the MCA (M1) origin and the aneurysmal neck is key to selection of the approach: LS was used for MCA aneurysms <15 mm from the M1 origin and MP for MCA aneurysms ≥15 mm from the M1 origin.

RESULTS

11 of 50 patients presented with subarachnoid hemorrhage (10 ruptured MCA aneurysms). Overall, 59 aneurysms were successfully clipped (54 of the MCA). The mean distance between the M1 origin and the aneurysmal neck was 10.1 mm (range, 4-17 mm) for patients treated by LS and 20 mm (range, 15-30 mm) for those treated by MP. All but 1 MCA aneurysms were successfully treated. At last follow-up (mean, 14 months), no reperfusion of the clipped aneurysms was observed.

CONCLUSION

Our strategy for selecting the keyhole approach based on the depth of the aneurysm within the Sylvian fissure is efficient and safe. We suggest the use of the LS approach when the aneurysm is <15 mm from the M1 origin and the MP approach when the aneurysm is ≥15 mm from the M1 origin.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2019
Deposited On:18 Feb 2020 14:34
Last Modified:23 Feb 2020 07:01
Publisher:Elsevier
ISSN:1878-8750
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.wneu.2018.09.238
PubMed ID:30326308

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