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.
