Keyhole Approaches Applied to Clipping of Acutely Ruptured Intracerebral Aneurysms—A Technical Note and Case Series

Rapid evolution of endovascular techniques in the management of cerebral aneurysms has limited the scope of surgical intervention for these lesions significantly.1 While endovascular technologies are evolving rapidly, equivalent evolution in surgical technique remains relatively stagnant.2 One key differentiator between “open” and “closed” techniques, making endovascular techniques more acceptable to patients, is the perceived “less invasiveness” of endovascular aneurysm treatment compared with classical “open surgery.”2

The workhorse approach for successful surgical treatment of anterior circulation cerebral aneurysms is the classic pterional approach, which was popularized by Professor Yasargil.3 Although this approach is revolutionary in decreasing the amount of brain retraction required for visualization of critical anatomy, it requires a large incision and leads to significant temporalis atrophy, facial asymmetry, risk of temporomandibular joint disfunction, and unnecessary exposure of large areas of cortex. These factors can adversely affect the length of hospital stay, return to employment, and activities of daily living.4 In an attempt to address these shortcomings and thereby improve cosmesis, postoperative pain, in-hospital stay, and ultimately tolerability, there has been a conscious effort to explore the application of minimally invasive techniques to aneurysm surgery.2,4, 5, 6, 7 Several published series have explored keyhole techniques as applied to aneurysm surgery.2,8 The majority of these series tend to analyze a single approach and also explore the use of keyhole techniques in unruptured aneurysms.2,8 Here, we present our series exploring the application of keyhole techniques for the surgical clipping of acutely ruptured aneurysms in consecutive patients. Variations of supraorbital, minipterional, and keyhole interhemispheric approaches were used on the basis of the presenting ruptured aneurysm site and individual anatomy. Cases were performed in a setting that does not have access to endovascular services and were performed by the senior author (C.P.).

留言 (0)

沒有登入
gif