Artikel
One-stage clipping of bilateral middle cerebral aneurysms via distal trans-sylvian key-hole approach
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Multiple cerebral aneurysms are commonly amenable to endovascular embolization. Considering therapeutic curativity, we applied one-stage clipping by using minimally invasive approach, even for bilateral aneurysms. Hereby the authors report its surgical technique and their initial treatment result.
Methods: Six patients underwent one-stage clipping of unruptured aneurysms in the bilateral middle cerebral arteries (mean size 5.6 mm, range 2 to 13 mm) via distal trans-sylvian key-hole approach in our institute. Mean patient age was 58 years (range 42 to 73 years). Technical tips are as follows; a patient head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; 5 cm curvilinear skin incision is made inside the hairline and 2-burr-hole small pterional craniotomy is made bilaterally; whole operating table is rotated 15 degree to one side to facilitate microsurgical trans-sylvian approach and aneurysmal clipping; operating table is rotated to the other side for the contralateral procedure; particular care is taken to avoid bilateral brain injury.
Results: This approach provided minimal but sufficient working space required for trans-sylvian approach. Aneurysmal neck clipping was safely performed with no complications and satisfactory cosmetic result in all patients. Mean operation time was 5 hours 17 minutes excluding one patient, who underwent bilateral manipulation separately. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimal consequence of brain retraction.
Conclusions: One-stage clipping via distal trans-sylvian key-hole approach is a safe and effective therapeutic option for small aneurysms in the bilateral hemispheres.