J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):235-240. 10.7461/jcen.2014.16.3.235.

The Usefulness of the Frontolateral Approach as a Minimally Invasive Corridor for Clipping of Anterior Circulation Aneurysm

• Yang J
• Oh CW
• Kwon OK
• Hwang G
• Kim T
• Moon JU
• Ahn SY
• Kim JH
• Kim J
• Bang JS

• KMID: 1963161
• DOI: http://doi.org/10.7461/jcen.2014.16.3.235

Abstract

OBJECTIVE
Several studies have reported on the effectiveness of fronto-lateral craniotomy in reducing the operating time and post-operative complications. However, no study has practically evaluated this method from the cosmetic point of view.
MATERIALS AND METHODS
We designed this study for comparison of the clinical differences and cosmetic outcomes between the frontolateral craniotomy and the conventional pterional craniotomy for clipping of unruptured intracranial aneurysms. We performed a retrospective analysis of the two groups based on their medical records and radiologic findings juxtaposed with their length of hospital stay, intensive care unit day and operation time, and the emergence of postoperative complication, mean size of aneurysm, and temporal depression.
RESULTS
After careful comparison of the thickness of temporalis muscle between the craniotomy side and the contralateral side, the results clearly showed that the conventional pterional craniotomy group was asymmetric by a p value of 0.152 and the frontolateral craniotomy group was symmetric by a p value of 0.002.
CONCLUSION
Frontolateral craniotomy could be a practical alternative for patients with an unruptured intracranial aneurysm in the anterior circulation including the posterior communicating artery, particularly those who are in a medically poor state or who highly demand minimal aesthetic mutilation.

Keyword

Frontolateral craniotomy; Temporal depression; Conventional pterional craniotomy; Unruptured intracranial aneurysm; Clipping; Minimal aesthetic mutilation

MeSH Terms

Aneurysm*
Arteries
Craniotomy
Depression
Humans
Intensive Care Units
Intracranial Aneurysm
Length of Stay
Medical Records
Postoperative Complications
Retrospective Studies

Figure

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  Fig. 1 (A) Minimal hair shaving was performed and the skin incision was short and was behind the hair line; (B) Only one burr hole is placed posteriorly just below the insertion line of the temporal muscle; (C) The mean size of the bone flap was 4×2.5 cm; (D) The temporal muscle is split only in its superior and anterior part. And in closure the bone flap was fixated with a skull fixator and a cranial plate.

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  Fig. 2 The size of the craniotomy is absolutely sufficient to reach the whole anterior part of the circle of Willis, sellar, suprasellar legion and also the anterior part of the basilar artery if it is located superiorly from the posterior clinoid process.

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  Fig. 3 Bilateral symmetry of temporalis muscle was measured through computed tomography taken six months after the operation.

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