Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings-One-Stage Surgery with Multiple Craniotomies

OBJECTIVE

The treatment of multiple intracranial aneurysms (MIAs) involves various modalities and sometimes requires staged operations. This study aimed to prove the efficacy and safety of one-stage multiple craniotomies (OSMC) for multiple cerebral aneurysms.

METHODS

We retrospectively reviewed the medical records of the patients who underwent treatment for intracranial aneurysms between May 2003 and April 2020. The surgical results, complications, and lengths of hospital stay were compared between the patients who underwent OSMC and those who underwent multistage multiple craniotomies.

RESULTS

The demographic characteristics of the OSMC and multistage multiple craniotomies groups (n = 82 and 43, respectively) were similar. There were no statistically significant differences between the 2 groups when the amount of blood transfused, complications, and surgical results were compared (P = n.s. for all); however, the operation time and hospitalization period (353.9 minutes vs. 490.3 minutes and 12.3 days vs. 21.8 days, respectively; P = 0.001 for both) were shorter in the OSMC group. The treatment cost (17,000 USD vs. 22,000 USD, P = 0.001) was lower in the OSMC group.

CONCLUSIONS

OSMC for aneurysm clipping in patients with MIAs is a relatively safe and economical method. Furthermore, it has good clinical outcomes. This new surgical method is worthwhile in that it can be applied to patients who are afraid to undergo multiple surgeries, and we suggest that it is an efficient, low-cost option for the treatment of MIAs.

1.5 Tesla Non-ultrashort but Short Echo Time Magnetic Resonance Angiography Describes the Arteries Near a Clipped Cerebral Aneurysm

Cerebral aneurysm and mother artery assessment after clipping is essential to evaluate aneurysm remnant, regrowth, and clip slippage. Usually, cerebral angiography and contrast-enhanced computed tomography angiography (CTA) are used for the evaluation, but they have the side effect of contrast medium and are time-consuming. Time-of-flight magnetic resonance angiography (TOF-MRA) is a non-invasive and fast modality, but clip-induced artifacts limit the signal near the metal clip. Recent ultrashort echo time (UTE)-MRA reduces metal artifacts but its availability is still low worldwide. Therefore, we developed a modified TOF-MRA sequence, named short TE-MRA, using Optima MR 360 1.5T Advance (GE Healthcare Life Sciences, Buckinghamshire, UK). It could describe the artery near the clip using general MRA equipment without recent UTE-MRA technology. We present a subarachnoid hemorrhage patient who underwent short TE-MRA about a year after clipping for the aneurysms at the bilateral internal carotid arteries. Short TE-MRA described the left internal carotid, middle cerebral, and anterior cerebral arteries. The right middle and anterior cerebral arteries were described, but the right internal carotid artery was not. Normal TOF-MRA could not describe them. Without recent UTE-MRA technology, short TE-MRA might be an alternative method for evaluating the artery near the clip. Short TE-MRA can be performed by general MRA equipment with a little time, so it may be helpful until UTE-MRA is widely used. Further research is needed on whether short TE-MRA can describe the aneurysm remnant, regrowth, and clip slippage up to the clinically useful level.