Introduction: to present the authors clinical experience with the minipterional craniotomy in more than one hundred ruptured and unruptured anterior circulation aneurysms.
Methods: from August 2005 to July 2013 86 consecutive patients with 102 ruptured non-giant, anterior circulation aneurysms were treated with early surgery with the minipterional craniotomy.
Results: Thirty-seven patients (43%) presented with subarachnoid hemorraghe (SAH), while 49 (57%) patients had unruptured aneurysms. Twenty-four patients (64.8%) were classified as Fisher 3 and 4, and 13 categorized as Fischer 1 and 2 (35.1%). Seven patients (18.9%) presented in Hunt Hess 1, 15 (40.5%) in Hunt Hess 2, 2 (32.4%) in Hunt Hess 3 and 3 (8.1%) patients in Hunt Hess 4. Twelve patients (32.4%) need external ventricular shunt due to acute hydrocephalus.Thirty patients (81%) with ruptured aneurysms were operated on until day five after SAH. Postoperative angiogram was carried out in all cases. Results were excellent in 67(77.9% - mRS 0 or 1)), good in 7(8,1% - mRS 2 or 3) of the cases and 12(13.9%) patients deceased.
Conclusions: the minipterional technique provides adequate surgical exposure and excellent outcomes for both ruptured and unruptured anterior circulation aneurysms clipping. It constitutes a safe and effective alternative to the pterional approach, with potential better aesthectic and functional outcomes.
Patient Care: teaching new surgical techniques to minimally invasive approach brings benefits to surgery faster and with better esthetic results
Learning Objectives: To describe the use of minimally invasive craniotomy to approach in cerebral aneurysm
teaching surgical technique for residents
References: 1: Caplan JM, Papadimitriou K, Yang W, Colby GP, Coon AL, Olivi A, Tamargo RJ, Huang J. The Minipterional Craniotomy for Anterior Circulation Aneurysms: Initial Experience with 72 Patients. Neurosurgery. 2014 Mar 12.
2: Yonekawa Y. [Operative neurosurgery: personal view and historical backgrounds. Anterior circulation--pterional approach]. No Shinkei Geka. 2007;35(7):703-18.
3: Dunn GP, Nahed BV, Walcott BP, Jung H, Tierney TS, Ogilvy CS. Dual ipsilateral craniotomies through a single incision for the surgical management of multiple intracranial aneurysms. World Neurosurg. 2012;77(3-4):502-6.
4: Cheng WY,Lee HT, Sun MH, Shen CC. A pterion keyhole approach for the treatment of anterior circulation aneurysms. Minim Invasive Neurosurg. 2006 ;49(5):257-62.