Experience of using keyhole approaches in the staged surgery of multiple cerebral aneurysms
Abstract
OBJECTIVE. Evaluation of the experience of using a differenced approach in the choice of approach in multiple aneurysm surgery using the concept of keyhole surgery.
MATERIALS AND METHODS. The work is based on a retrospective analysis of the use of minimally invasive approaches in the surgery of multiple aneurysms in 11 patients in the period 2015–2018, including patients in the acute period of subarachnoid hemorrhage as the second step of the operation. Тhеrе were evaluated functional and cosmetic outcomes of keyhole approaches, outcomes for mRs and the Glasgow outcome scale.
RESULTS. The main parameters evaluation were: numbness of the supraorbital region, the function of the frontal branch of the facial nerve, hyposmia, infectious complications and CSF leakage. 9 patients had an outcome in the Glasgow V outcome scale (81.8%), and 2 — IV (18.2%). According to the modified Rankin scale: in 9 patients the outcome was 1 (81.8%), in 2 patients — 2 (18.2%). Cosmetic and functional outcomes from traditional approaches were also evaluated.
CONCLUSIONS. The clinical outcome is determined by the patient’s initial condition. Taking into account the results of our research, the concept of keyhole is considered as one of the options in the treatment of multiple aneurysms with adequate selection of patients.
About the Authors
R. S. Dzhindzhikhadze
Moscow Regional Research and Clinical Institute (“MONIKI”); Department of Neurosurgery FGBOU DPO RMANPO, The Ministry of Health; City Clinical Hospital named after F. I. Inozemtseva
Russian Federation
Russian Federation
O. N. Dreval
Department of Neurosurgery FGBOU DPO RMANPO, The Ministry of Health
Russian Federation
Russian Federation
V. A. Lazarev
Department of Neurosurgery FGBOU DPO RMANPO, The Ministry of Health
Russian Federation
Russian Federation
A. V. Polyakov
Department of Neurosurgery FGBOU DPO RMANPO, The Ministry of Health; City Clinical Hospital named after F. I. Inozemtseva
Russian Federation
Russian Federation
References
1. Lawton M, Quinones-Hinojosa A, Sanai N, Malek JY, Dowd CF. Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery. 2003;52(2):263–74; discussion 274–5. https://doi.org/10.1227/01.neu.0000043642.46308.d1
2. Dzhindzhikhadze R. S., Dreval’ O.N., Lazarev V. A., Kambiev R. L. The KEYHOLE concept in neurosurgery of aneurysms. Neirokhirurgiya i nevrologiya Kazakhstana. 2015; 2(43): 16–23. (In Russ.)
3. Dzhindzhikhadze R. S., Dreval’ O.N., Lazarev V. A., Kambiev R. L., Bogdanovich I. O., Davudov A. M. Keyhole-approaches for surgical treatment of cerebral aneurysms of anterior circulation. Russian journal of neurosurgery. 2017;(1):23–30. (In Russ.)
4. Dzhindzhikhadze R. S., Dreval’ O.N., Lazarev V. A., Kambiev R. L. Supraorbital keyhole craniotomy in surgery of anterior circle of willis aneurysms. Zhurnal «Voprosy neirokhirurgii» imeni N. N. Burdenko. 2016;80(5):78–84. (In Russ.) https://doi.org/10.17116/neiro201680578–84
5. Dzhindzhikhadze R. S., Dreval’ O. N., Lazarev V. A., Polyakov A. V., Kambiev R. L. Transpalpebral craniotomy in skull base surgery. Zhurnal «Voprosy neirokhirurgii» imeni N. N. Burdenko. 2018;82(2):48–58. (In Russ.) https://doi.org/10.17116/oftalma201882248–58
6. Heiskanen O. Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg. 1981;55(4):524– 526. https://doi:10.3171/jns.1981.55.4.0524
7. Poppen J., Fager C. Multiple Intracranial Aneurysms. J Neurosurg. 1959;16(5):581–589. https://doi:10.3171/jns.1959.16.5.0581
8. Suzuki J., Sakura Y. The treatment of intracranial multiple aneurysms. In: Suzuki J, ed. Cerebral Aneurysms. Tokyo: Neuron, 1979:293–307
9. Milenković Z., Gopić H., Antović P., Joviĉić V., Petrović B. Contralateral pterional approach to a carotid-ophthalmic aneurysm ruptured at surgery. J Neurosurg. 1982;57(6):823–825. https://doi:10.3171/jns.1982.57.6.0823
10. De Benedittis G, Infuso L. Multiple intracranial aneurysms. J Neurosurg Sci 1977; 21: 171–184
11. De Oliveira E, Tedeschi H, Siqueira M, Ono M, Fretes C, Rhoton AL Jr, Peace DA. Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (Wien). 1996;138(1):1–11. https://doi:10.1007/bf01411716
12. Vajda J. Multiple intracranial aneurysms: A high risk condition. Acta Neurochir (Wien). 1992;118(1–2):59–75. https://doi:10.1007/bf01400727
13. Yasargil MG. Microneurosurgery, Volume 2. New York. Thieme, Stratton, 1984
14. Yasargil MG, Gasser JC, Hodosh RM, Rankin TV. Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol. 1977;8(3):155–65
15. Vajda J, Juháasz J, Pásztor E, Nyáary I. Contralateral Approach to Bilateral and Ophthalmic Aneurysms. Neurosurgery. 1988;22(4):662– 668. https://doi:10.1227/00006123–198804000–00007
16. Krylov V. V., Gel’fenbein M. S. Ispol’zovanie kontralateral’nogo pterional’nogo dostupa v khirurgii anevrizm golovnogo mozga. Zhurnal «Voprosy neirokhirurgii» imeni N. N. Burdenko. 1998; 4: 9–17. (In Russ.)
17. Krylov V.V, Tkachev V. V., Dobrovol’skii G. F. Kontralateral’naya khirurgiya anevrizm golovnogo mozga. Moskva, meditsina; 2002. (In Russ.)
18. Kheireddin A. S., Filatov Yu.M., Yakovlev S. B., Belousova O. B., Pronin I. N., Kaftanov A. N., Dmitriev A. V. Khirurgicheskoe lechenie mnozhestvennykh tserebral’nykh anevrizm. Izdatel’stvo IP “T. A. Alekseeva” Moskva; 2018. (In Russ.)
19. Wiebers D. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. The Lancet. 2003;362(9378):103–110. https://doi:10.1016/s0140–6736(03)13860–3
20. Martellotta N, Gigante N, Toscano S, Maddalena GF, Tripodi M, Settembrini G, Stroscio C, Distefano G, Citro E. Unilateral Supraorbital Keyhole Approach in Patients with Middle Cerebral Artery (M1-M2 Segment) Symmetrical Aneurysms. min — Minimally Invasive Neurosurgery. 2003;46(4):228–230. https://doi:10.1055/s-2003–42359
21. Czirják S, Nyáry I, Futó J, Szeifert G. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol. 2002;57(5):314–323. https://doi:10.1016/s0090–3019(02)00698–5
22. Hopf N, Stadie A, Reisch R. Surgical Management of Bilateral Middle Cerebral Artery Aneurysms via a Unilateral Supraorbital Key-Hole Craniotomy. min — Minimally Invasive Neurosurgery. 2009;52(03):126–131. https://doi:10.1055/s-0029–1225618
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For citations:
Dzhindzhikhadze R.S., Dreval O.N., Lazarev V.A., Polyakov A.V. Experience of using keyhole approaches in the staged surgery of multiple cerebral aneurysms. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2019;11(4):17-24. (In Russ.)
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