J Korean Neurosurg Soc.  2012 Oct;52(4):306-311. 10.3340/jkns.2012.52.4.306.

Unruptured Supraclinoid Internal Carotid Artery Aneurysm Surgery : Superciliary Keyhole Approach versus Pterional Approach

• Shin D
• Park J

• KMID: 2190645
• DOI: http://doi.org/10.3340/jkns.2012.52.4.306

Abstract

OBJECTIVE
A superciliary keyhole approach is an attractive, minimally invasive surgical technique, yet the procedure is limited due to a small cranial opening. Nonetheless, an unruptured supraclinoid internal carotid artery (ICA) aneurysm can be an optimal surgical target of a superciliary approach as it is located in the center of the surgical view and field. Therefore, this study evaluated the feasibility and surgical outcomes of a superciliary keyhole approach for unruptured ICA aneurysms.
METHODS
The authors report on a consecutive series of patients who underwent a superciliary approach for clipping unruptured ICA aneurysms between January 2007 and February 2012. The data were compared with a historical control group who underwent a pterional approach between January 2003 and December 2006.
RESULTS
In the superciliary group, a total of 71 aneurysms were successfully clipped without a residual sac in 70 patients with a mean age of 57 years (range, 37-75 years). The maximum diameter of the aneurysms ranged from 4 mm to 14 mm (mean+/-standard deviation, 6.6+/-2.3 mm). No direct mortality or permanent morbidity was related to the surgery. The superciliary approach demonstrated statistically significant advantages over the pterional approach, including a shorter operative duration (mean, 100 min), no intraoperative blood transfusions, and no postoperative epidural hemorrhages.
CONCLUSION
A superciliary keyhole approach provides a sufficient surgical corridor to clip most unruptured supraclinoid ICA aneurysms in a minimally invasive manner.

Keyword

Cerebral aneurysm; Internal carotid artery; Minimal surgical procedure; Treatment outcome

MeSH Terms

Aneurysm
Blood Transfusion
Carotid Artery, Internal
Humans
Intracranial Aneurysm
Surgical Procedures, Minimally Invasive
Treatment Outcome

Figure

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  Fig. 1 Intraoperative photographs showing superciliay keyhole approach for supraclionoid internal carotid artery aneurysms. A : Supraorbital mini-craniotomy. B : 2.5-cm dural opening. C : Posterior communicating artery aneurysm (arrow). D : Clipped posterior communicating artery aneurysm. E : Anchor screw (arrow) for dural tenting sutures. F : Porous high-density polyethylene implants (arrows) filling burrhole and bone gaps.

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