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Bhattarai HB, Sapkota S, Mandal P, Bhattarai M, Pathak R. Arachnoid cyst presenting as a neurosurgical emergency: a case report. Ann Med Surg (Lond) 2023; 85:6164-6167. [PMID: 38098583 PMCID: PMC10718336 DOI: 10.1097/ms9.0000000000001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Arachnoid cysts are intra-arachnoid lesions filled with cerebrospinal fluid. They account for ~1% of all intracranial mass lesions and are non-neoplastic collections of cerebrospinal fluid within an anomalous arachnoid enclosure. Case presentation The authors report a 35-year-old Arabian male who presented to the ER with a history of sudden loss of consciousness, anisocoria, and right hemiparesis. Contrast tomography showed a large frontoparietotemporal cyst (7.7×5.8×5.4) with uncal herniation and a midline shift of 12 mm. An emergency left FTP craniotomy with an excision of the cyst was performed. Discussion Arachnoid cysts can be categorized as primary or secondary, arising congenitally or due to factors like trauma, infection, or neoplasia. It can rupture, leading to internal bleeding, causing symptoms such as headaches, seizures, and neurological decline. Rapid diagnosis is vital, with cranial computed tomography scans preferred for emergencies. Treatment options include surgical intervention like craniotomy, fenestration, or cyst peritoneal shunts. For uncal herniation, surgery can be successful and results depends on the amount of herniation. Conclusion Although benign, the arachnoid cysts led to uncal herniation when they become 'tension' cysts. A high level of suspicion is crucial for early recognition of the condition. Timely intervention has shown positive recovery outcomes.
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Affiliation(s)
| | | | - Prince Mandal
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Madhur Bhattarai
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Roshan Pathak
- Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
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Merola J, Manivannan S, Ooi S, Li Chia W, Makwana M, Lang J, Leach P, Zaben MJ. The efficacy of cystoperitoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: A systematic review of the literature. Surg Neurol Int 2022; 12:624. [PMID: 34992940 PMCID: PMC8720472 DOI: 10.25259/sni_463_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort. Methods: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed. Results: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma. Conclusion: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.
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Affiliation(s)
- Joseph Merola
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton General Hospital, Southampton General Hospital, Southampton, United Kingdom
| | - Setthasorn Ooi
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, University Hospital of Wales, United Kingdom
| | - Wen Li Chia
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, University Hospital of Wales, United Kingdom
| | - Milan Makwana
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Jozsef Lang
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Paul Leach
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Malik J Zaben
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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Fonseca RB, Correia AO, Vieira RS, Dos Santos JEF, Alves-Neto HR, da Silva Vieira AF, Belém DRF, Tobias-Machado M, Vidal CHF, Waisberg J. Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting. Sci Rep 2021; 11:5555. [PMID: 33692472 PMCID: PMC7946868 DOI: 10.1038/s41598-021-85115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC). The results of these two techniques are compared. 35 patients underwent SOMC, compared to 50 patients underwent CP (100 aneurysms in total), using the same microsurgical instruments. The following variables were compared: operative time, angiographic cure, length of intensive care unit stay during the post-operative period, surgical complications, length of hospital stay after surgery until hospital discharge, intraoperative aneurysm rupture, aesthetic satisfaction with the scar, and neurological status at discharge. SOMC had a significantly shorter operative time in relation to PC (213.9 ± 11.09 min and 268.6 ± 15.44 min, respectively) (p = 0.0081).With respect to the cosmetic parameters assessed by the Visual Analog Scale, the average for SOMC was 94.12 ± 1.92 points, and the average for PC was 83.57 ± 4.75 points (p = 0.036). SOMC was as effective as PC in relation to successful aneurysm clipping (p = 0.77). The SOMC technique did not show advantages over PC in any other variable. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction.
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Affiliation(s)
- Ricardo Brandão Fonseca
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil.
| | - Alyne Oliveira Correia
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Raysa Siqueira Vieira
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - José Erivaldo Fonseca Dos Santos
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Heverty Rocha Alves-Neto
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Anajara Ferraz da Silva Vieira
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | - Diego Ramon Ferreira Belém
- Department of Neurology and Neurosurgery, University Hospital, Universidade Federal do Vale do São Francisco, Petrolina, Pernambuco, Brazil
| | | | | | - Jaques Waisberg
- Department of Surgery, ABC Medical School, Santo André, São Paulo, Brazil
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Konar S, Rao KVLN, Nandeesh BN, Sampath S. Delayed presentation of primary parenchymal arachnoid cyst in adult population: a rare location of a common cyst—case report and review of the literature. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dlaka D, Raguž M, Muller D, Romić D, Almahariq F, Dlaka J, Kaštelančić A, Chudy D. Intraparenchymal supratentorial arachnoid cyst: a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0053-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intracranial arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane and subarachnoid space of the cisterns and major cerebral fissures that account for about 1% of all intracranial lesions. Expansion of the cyst and compression on surrounding structures may became symptomatic, which reflects its size and anatomic distribution.
Case presentation
Here, we present a very rare case of patient with supratentorial intraparenchymal arachnoid cyst placed in the left frontal lobe without any communication with the subarachnoid space and ventricle and presented with clinical symptoms. The patient underwent fenestration of the lesion and was clinically improved.
Conclusions
Although the etiology and the enlargement mechanism of arachnoid cysts remain unclear, both conservative and surgical treatments are optional. According to size, anatomical location, neuroimaging, and clinical symptoms, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.
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A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults. World Neurosurg 2019; 123:e259-e272. [DOI: 10.1016/j.wneu.2018.11.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
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Needle aspiration as an alternative treatment for glio-ependymal cysts. Acta Neurochir (Wien) 2018; 160:2007-2008. [PMID: 30120540 DOI: 10.1007/s00701-018-3660-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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8
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Champagne PO, Decarie JC, Crevier L, Weil AG. Dissecting spontaneous cerebrospinal fluid collection. Med Hypotheses 2018. [PMID: 29523303 DOI: 10.1016/j.mehy.2018.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hydrocephalus is a common condition in the pediatric population known to have many causes and presentation patterns. We report from the analysis of 2 cases the existence of a new complication of pediatric hydrocephalus. Naming this entity "dissecting intraparenchymal cerebrospinal fluid collection", we advance a hypothesis regarding its pathophysiology and discuss its clinical implications and management.
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Affiliation(s)
- Pierre-Olivier Champagne
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
| | - Jean-Claude Decarie
- Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Louis Crevier
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander G Weil
- Pediatric Neurosurgery Service, Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms. Neurosurg Rev 2014; 37:629-36. [DOI: 10.1007/s10143-014-0562-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 02/19/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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10
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Intracerebral arachnoid cyst treated with ommaya reservoir implantation in a patient younger than two years. J Craniofac Surg 2014; 25:e378-80. [PMID: 24943503 DOI: 10.1097/scs.0000000000000926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intracranial arachnoid cysts are rare cystic-appearing intracranial masses. In rarer cases, the arachnoid cysts originate from brain parenchyma, which is defined as intracerebral arachnoid cyst. Here, we present a patient younger than 2 years with massive intracranial arachnoid cysts (one of which was intracerebral arachnoid cyst), whose clinical symptoms included megacephaly and limb weakness. Ommaya reservoir implantation and repeated aspiration of the intracerebral cyst fluid were performed. The symptoms gradually improved, and the intracerebral arachnoid cyst gradually disappeared during 13 months of follow-up. The case highlights the potential of Ommaya reservoir implantation in the treatment of intracerebral arachnoid cyst, especially for young patients. We also reviewed the published literatures concerning the rare condition, including the mechanisms for its pathogenesis and enlargement.
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11
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Lemercier S, Haegelen C, Riffaud L. [Intracerebral cysts revealed by extrapyramidal symptoms]. Neurochirurgie 2014; 60:59-61. [PMID: 24613423 DOI: 10.1016/j.neuchi.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/23/2013] [Accepted: 11/13/2013] [Indexed: 11/27/2022]
Abstract
We report 3 cases of intracerebral cyst revealed by an unusual evolution of extrapyramidal symptoms. Diagnosis was based on MRI and the patients were treated by a cystoperitoneal or a cysto-atrial shunt. The surgical procedure was successful in the 3 cases, resulting in the rapid disappearance of symptoms.
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Affiliation(s)
- S Lemercier
- Service de neurologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - C Haegelen
- Service de neurochirurgie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - L Riffaud
- Service de neurochirurgie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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Graillon T, Metellus P, Adetchessi T, Dufour H, Fuentes S. Adult symptomatic and growing arachnoid cyst successfully treated by ventriculocystostomy: a new insight on adult arachnoid cyst history. Neurochirurgie 2013; 59:218-20. [PMID: 24210287 DOI: 10.1016/j.neuchi.2013.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/04/2013] [Accepted: 09/28/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adult arachnoid cysts are known to be stable and asymptomatic but their history remains undefined. CASE DESCRIPTION The authors report the case of an 81-year-old woman with progressive hemiplegia and aphasia. CT scan revealed a voluminous left frontotemporal arachnoid cyst with a major mass effect on the midline and contralateral blocked hydrocephalus. Endoscopic ventriculocystostomy was performed with a spectacular neurological improvement. DISCUSSION AND CONCLUSIONS Symptomatic adult arachnoid cysts are extremely rare. To our knowledge, no similar clinical case of a growing arachnoid cyst in elderly patients has yet been reported in the literature. The mechanisms of cyst enlargement and decompensation still remain undefined and debated. The possibility of adult arachnoid cyst growth has to be considered in clinical practice. Endoscopic ventriculocystostomy is as effective as in paediatric cases.
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Affiliation(s)
- T Graillon
- Aix-Marseille université, 13284 Marseille, France; Service de neurochirurgie, hôpital la Timone Adulte, AP-HM, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Zheng J, Wang J, Wang S, Cao Y, Zhao J. Serial observation of an enlarging intracerebral arachnoid cyst. Clin Neurol Neurosurg 2013; 115:227-31. [DOI: 10.1016/j.clineuro.2012.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/03/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
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Zador Z, Gnanalingham K. Eyebrow craniotomy for anterior skull base lesions: how I do it. Acta Neurochir (Wien) 2013; 155:99-106. [PMID: 23135067 DOI: 10.1007/s00701-012-1552-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The eyebrow craniotomy is a less invasive alternative approach for accessing anterior skull base lesions, compared to traditional and more extensive exposures. We give a stepwise description of this minimally invasive technique with discussion on the indications, limitations and key aspects of perioperative management. METHODS Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion. The eyebrow incision should spare the medial and posterolateral neural structures. Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the "keyhole effect" for accessing a larger target. Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. CONCLUSION The eyebrow craniotomy may be safely used as a minimally invasive approach for a variety of anterior skull base lesions. There is an operative learning curve and some types of pathologies are easier to approach by this technique than others. KEY POINTS • The eyebrow craniotomy is an alternative less invasive approach for accessing anterior skull base lesions • Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion • Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. • Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the "keyhole effect" for accessing a larger target • Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. • There is an operative learning curve and some types of pathologies are easier to approach by this technique than others.
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Shin D, Park J. Unruptured Supraclinoid Internal Carotid Artery Aneurysm Surgery : Superciliary Keyhole Approach versus Pterional Approach. J Korean Neurosurg Soc 2012; 52:306-11. [PMID: 23133717 PMCID: PMC3488637 DOI: 10.3340/jkns.2012.52.4.306] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 09/07/2012] [Accepted: 10/04/2012] [Indexed: 11/27/2022] Open
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.
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Affiliation(s)
- Donguk Shin
- Department of Neurosurgery, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Korea
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Park J, Kang DH, Chun BY. Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy: maximizing symptomatic resolution and minimizing surgical invasiveness. J Neurosurg 2011; 115:700-6. [DOI: 10.3171/2011.5.jns102087] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
For oculomotor nerve palsy (ONP) induced by unruptured posterior communicating artery (PCoA) aneurysms, the authors performed surgical clipping via a superciliary keyhole approach as an optimal treatment modality with high efficiency and low invasiveness. In this study, they then evaluated the technical feasibility, safety, clinical outcomes, including recovery from ONP as well as cosmetic results, and durability of the procedure.
Methods
Thirteen patients presenting with complete (7 patients) or incomplete (6 patients) ONP underwent surgery via a superciliary approach. The operative video record was used to evaluate the technical feasibility, neurological examinations and CT were performed to analyze the safety of the treatment, and neuroophthalmological examinations and 3D CT angiography were undertaken to determine the effectiveness and durability of the treatment.
Results
In all cases, the aneurysms were successfully clipped using a 3.5-cm eyebrow incision and supraorbital minicraniotomy. The mean operative time was 108 ± 24 minutes. Twelve (92.3%) of the 13 patients showed complete resolution of the ONP. All 6 patients (100%) with incomplete ONP recovered completely within 1–2 months after surgery, whereas 6 (85.7%) of the 7 patients with complete ONP recovered completely within 1–6 months after surgery. Cosmetic results for the operative wounds were excellent without frontalis palsy. The durability of the treatment was ascertained based on 3D CT angiograms obtained 1 year after surgery.
Conclusions
Surgical clipping via a superciliary keyhole approach can be an optimal treatment modality for PCoA aneurysms inducing ONP because it is effective, safe, and durable.
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Affiliation(s)
| | | | - Bo-Young Chun
- 2Ophthalmology, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea
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