engleski

Minimally Invasive Keyhole Approach To Mca Aneurysms

Introduction: Middle cerebral artery aneurysms account for 20 to 30 percent of all intracranial aneurysms. Depending on their location, orientation and surgical planning are addressed by different surgical approaches. Since 1996 a total number of 1280 intracranial aneurysms have been operated on at our institution using minimally invasive concept. We analyze the advantages of the minimally invasive keyhole approach compared to pterional approach in patients with MCA aneurysms. Material and Method: We retrospectively analyzed data of the patients that harboured MCA aneurysms that were surgically treated at our Department during the past 10 years. Surgical approach was based on location and size of the aneurysm as well as variations in MCA anatomy and fundus orientation. Results: From January 2002 to December 2012, 879 patients with aneurysms of various locations were surgically treated at our Department. The proportion of MCA aneurysms comparing to other locations reached over 40% and still rises because the aneurysms on other locations are more frequently treated endovascularly. A total of 415 patients with 463 MCA aneurysms underwent surgery through a small eyebrow keyhole craniotomy and subfrontal route as the approach of choice. In 44 patients we performed either a temporal keyhole or pterional approach and lateral transsylvian route. Conclusions: In our experience, supraorbital keyhole with subfrontal approach has the advantage over the lateral transsylvian approach in earlier proximal artery control, excellent visualization of the aneurysm neck avoiding the fundus in the majority of cases and easier and most appropriate clip application. However, pterional approach is preferred for the distal MCA aneurysms, giant and wide neck aneurysms or additional vascular surgical procedures such as bypass, thrombectomy etc.

MCA aneurysms; Keyhole; Minimally invasive

nije evidentirano