Lamina Terminalis Fenestration in Ruptured Anterior Circulation Aneurysm for Hydrocephalus - The Limitations

Aim: The aim of the study is to analyze the usefulness of lamina terminalis fenestration (LTF) in hydrocephalus secondary tosubarachnoid hemorrhage while performing surgical interventions for anterior circulation aneurysm and to know the limitationsof this procedure in patients who undergo clipping of these aneurysms.Materials and Methods: A total of 81 aneurysms in 78 patients were included in this study from the year 2001 to 2018. Patientsin the age range of 12–80 years were included. Male-female ratio was 1:1.1. Until February 2011, LTF was done for 9 patientswho had any degree of hydrocephalus as an adjuvant to clipping of the anterior circulation aneurysms. After March 2011, insteadof LTF, intraoperative ventricular tapping was done in patients with hydrocephalus.Results: Among the 9 cases who had undergone LTF, two patients developed frontoparietal subdural hygromas with masseffect. From March 2011 till date after stopping LTF, only 2 of 47 patients required ventriculoperitoneal shunt who ultimatelydeveloped chronic hydrocephalus.Conclusion: LTF can lead to potential complications such as subdural hygromas due to poor absorption in blood cloggedsubarachnoid spaces. This procedure must be adopted with caution as it has its own limitations.

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.

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.

Middle cerebral artery aneurysms: challenges for microsurgical approach

The authors present their series about middle cerebral artery (MCA) aneurysms. They discuss anatomical aspects as well as the results and complications of surgical treatment. Besides, they defend the idea that for having good results, it is necessary an extent Sylvian´s cistern dissection, permitting an adequate exposure of the aneurysms and their relationships not only with the MCA but with its branches, emphasizing too the not usefulness of temporary clipping in the approach of this pathology.

Superior Orbital Rim Approach to the Anterior Circulation Aneurysms: Surgical Technique

OBJECTIVE: With the improvement of surgical techniques, instruments and diagnostic imaging, the aneurysmal surgery could be performed less invasively with less retraction of neural structure and more smaller craniotomy. The authors present a superior orbital rim approach as minimally invasive anterior circulation aneurysm surgery. METHODS: Superior orbital rim approach was performed for the treatment of the anterior circulation aneurysms with or without clinoidectomy. We considered the indications and limitations of this approach and compared this approach with conventional approaches. RESULTS: The operative technique can be used in all cases of anterior circulation aneurysms and could give us excellent results, especially, in internal carotid artery aneurysms. In cases of middle cerebral artery aneurysms, more wide and lateral approaches were used. In general, operation time was shortened and transfusion was not needed. CONCLUSION: The superior orbital rim approach is a good alternative procedure to conventional microsurgical approach in treating anterior circulation aneurysms.