The risk factors and preventions in keyhole minimally invasive approaches of intracranial aneurysms / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the risk factors and study the methods of prevention and treatment for the ruptures of aneurysms in keyhole minimally invasive approaches.</p><p><b>METHODS</b>From 1999 to 2005, 115 cases of intracranial aneurysms were divided into 2 classes according to the risk factors of aneurysm rupture. Forty-three cases of lower risk underwent microsurgical procedures as keyhole approaches, including pterional approach in 20 cases, supraorbital approach in 18 cases, interhemispheric approach in 5 cases. Seventy-two cases, rest of microsurgical procedures, were performed as conventional craniotomy, including pterional approach in 31 cases, supraorbital approach in 11 cases, interhemispheric approach in 7 cases, pterional-supraorbital in 10 cases, pterional-interhemispheric in 6 cases, supraorbital-interhemispheric in 4 cases, pterional-supraorbital-interhemispheric in 3 cases.</p><p><b>RESULTS</b>Six aneurysms leaked and 3 ruptured (rupture rate 7.0%) treated with keyhole approaches during operations. No one died by keyhole approaches. Eighteen aneurysms leaked and 9 ruptured (rupture rate 12.5%) treated with conventional approaches during operations. Two patients died by conventional approaches.</p><p><b>CONCLUSIONS</b>Keyhole approaches as a time-saving, trauma-reducing procedure could improve the postoperative outcomes, but these approaches still exist probability of aneurysm rupture. It is possible that keyhole-bone flap becomes a limitation to deal with huge or ruptured aneurysms. And it is important to make a specially preventive strategy for aneurysm rupture.</p>