Analysis of clinical effect of different approaches for clipping anterior circulation aneurysms / 重庆医学

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.

Effect of treatment for ruptured anterior communicating artery aneurysms with different dome projections in acute phase via supraorbital lateral approach / 中国脑血管病杂志

Objective To investigate the surgical efficacy for the treatment of ruptured anterior communicating artery aneurysms with different dome projections in acute phase via supraorbital lateral approach.Methods From January 2014 to March 2017,the clinical data of 79 patients with acute ruptured anterior communicating artery aneurysm with different dome projections in acute phase treated via supraorbital lateral approach in the First Affiliated Hospital of Soochow University were retrospectively analyzed.The operative efficacy was analyzed.The Glasgow outcome scale (GOS) score was used to evaluate the prognosis at 3-36 months after procedure.Results In the 79 patients,34 were superior dome projections,37 was inferior dome projections,and 8 were complicated dome projections.All the anterior communicating artery aneurysms were successfully clipped.The patients were followed up for 3-36 months after procedure.GOS showed good prognosis in 70 cases (88.6％),of which 26 were superior dome projections,36 were inferior dome projections,and 8 were complicated dome projections;9 suffered mild disability (11.4％),of which 8 were superior dome projections and 1 was inferior dome projection.There were no severe disability,persistent vegetative state,and death.The prognosis in patients with inferior dome projection was better than that of superior dome projection (97.3％ [36/37] vs.76.5％ [26/34]).The difference was statistically significant (χ2=5.19,P<0.05).Conclusions The lateral supraorbital approach is an effective option for treating ruptured ACoAA with different dome projections in acute phase.The prognosis in patients with inferior dome projection is better than that of superior dome projection.

Analysis of clinical effect of different approaches for clipping anterior circulation aneurysms / 重庆医学

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.

Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms

OBJECTIVE: The lateral supraorbital (LSO) approach is a modified method of the classic pterional approach and it has advantages of short skin incision and small craniotomy compared with the pterional approach. This study was designed to compare the two approaches in the surgical treatment of unruptured intracranial aneurysms. METHODS: We retrospectively reviewed 122 patients with 137 unruptured intracranial aneurysms treated by clipping, from July 2009 to April 2011. Between August 2010 and April 2011, 61 patients were treated by clipping via the lateral supraorbital approach and the same number of patients treated by clipping via the pterional approach were retrospectively enrolled. We analyzed the two groups and compared demographic, radiologic and clinical variables. RESULTS: The mean age of patients in the two groups was 54.6 years (LSO group) and 55.7 years (Pterion group). The mean duration of hospitalization was shorter in the LSO group than in the Pterion group (7.9 days vs. 9.0 days, p=0.125) and the mean operation time was also significantly shorter in the LSO group (117.1 minutes vs. 164.3 minutes, p<0.001). Furthermore, the mean craniotomy area was much smaller in the LSO group (1275.4 mm2 vs. 2858.9 mm2, p<0.001). The two groups showed similar distributions of aneurysm location and postoperative complications. CONCLUSION: The lateral supraorbital approach for the clipping of unruptured intracranial aneurysm could be a good alternative to the classic pterional approach.

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

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.

Trans-supraorbital Approach to Anterior Circulation Aneurysms / 대한뇌혈관학회지

BACKGROUND: The ultimate goal of minimally invasive surgery to the cerebral lesions is the smallest possible approach with an optimal surgical results. We present our experience in the surgery for anterior circulation aneurysms by using trans-supraorbital approach. METHODS: Between December 1998 and September 1999 seventeen patients with nineteen anterior circulation aneurysms were operated on via trans-supraorbital approach. Through a 4 to 5 centimeters long eyebrow or wrinkle incision trans-supraorbital approach was performed making a 3x2 cm bone flap including the orbital roof and rim. Advantages, indication of the this approach are discussed and surgical results are presented. RESULTS: All aneurysm were clipped without remmant. Outcome evaluated by the Glasgow outcome scale at 3 months after surgery was as follows; good recovery in 14 patients, moderate disability in 2 patients, severe disability in 1 patients. There was no procedure-related complications in our series. CONCLUSION: The trans-supraorbital approach to anterior circulation aneurysms may be the alternative minimally invasive approach in selected aneurysmal subarachnoid hemorrhage patients.

Supraorbital Approach to Anterior Skull Base and Intraorbital Lesions

To get effective access to the floor of the frontal fossa and the superior orbit, the resection of supraorbital rim has been done. We performed the supraorbital approach as combined technique with uni- or bifrontal craniotomy in order to minimize frontal lobe retraction and achieve excellent exposure for safe manipulation in seven patients of anterior skull base and intraorbital lesions. Of seven patients, two patients of olfactory groove meningioma underwent the operation with supraorbital bifrontal craniotomy;one patient of tuberculum sellar meningioma, bifrontal supraorbital-pterional approach;four patients of intraorbital benign lesions(one patient of meningioma, one patient of neurilemmoma, two patients of benign lesions in lacrimal gland), supraorbital unifrontal craniotomy. There was little or no functional, anatomical, or cosmetic deficit associated with this approach technique. We believe the supraorbital approach to be a helpful technique as combined procedure of the uni- or bifrontal approach and the approach of choice for the intraorbital tumors except those in the inferior portion.