Microsurgical treatment of the sacular supratentorial aneursmes

Abstract

The purpose of the study is to compare the results of minimally invasive keyhole craniotomy and standard larger craniotomies in the surgical treatment of patients with intracranial aneurysms. In the past 5 years 105 patients were operated by two experienced neurosurgical teams. The first group of 30 patients with 32 aneurysms were operated through a small keyhole craniotomy, using the eyebrow keyhole approach in particular. The remaining 75 patients with 82 aneurysms were operated using a standard craniotomy that included pterional/frontotemporal, frontoparietal parasagittal and retrosigmoid suboccipital craniotomies. All operations were performed in the standard microsurgical technique using intraoperative evoked potential monitoring and endoscopic assistance in selected cases. Results: Most supratentorial aneurysms and basilar tip aneurysms were successfully operated through an eyebrow keyhole craniotomy. Distal MCA aneurysms as well as aneurysms on the MCA with a long Ml segment were operated through a temporal keyhole, and aneurysms of the distal PCA (P2-P3) segment subtemporally. The frontoparietal parasagital keyhole approach was used only for pericallosaal artery aneurysms. Infratentorial aneurysmsof the VA/PICA complex were operated via a retrosigmoid approach. On comparing the surgery results in patients with a keyhole craniotomy and those with standard standard craniotomy, similar outcomes were found for both groups, with excellent or very good outcomes (GOS 5 and 4) in 23 (76.66%) patients from the keyhole craniotomy group, and in 51 (68%) patients from the standard craniotomy group. The mortality rate in the keyhole group was 5 (16,67%) and 15 (20%) in the standard craniotomy group. Parallel treatment results of using two options - keyhole craniotomy and standard larger cmiotomy - were analysed in the past 5 years. Two experienced neurosurgical teams in perfoming both surgical approaches have reached almost similar morbidity and moratlity rates, and overall surgical results. The type of craniotomy is selected according to the experience of the surgical team, and familiarity with certain aproach. The authors have good experience with the minimally invasive approach for different intracrainal pathology and recommend it especially in neurovascular surgery.