Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach

Mori, Kentaro

doi:10.4103/1793-5482.131059

Cited by 32 publications

(14 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is generally accepted that keyhole approach is suitable for aneurysmal clipping. 26 The main problem of the keyhole approach for poor-grade ruptured aneurysm is whether ideal relaxation of the brain tissue and the exposure of the aneurysm and its parent artery can be easily achieved during operation. Hydrocephalus and brain edema will hamper the relaxation of the brain tissue, which is associated with intraoperative CSF drainage.…”

Section: Discussionmentioning

confidence: 99%

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Zheng

Yao²,

Yu³

et al. 2015

Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Zheng

Yao²,

Yu³

et al. 2015

Medicine

View full text Add to dashboard Cite

show abstract

“…Figueiredo et al 5 demonstrated that the work area (area of exposure and working angle) in pterional mini-craniotomy is equivalent to classical access. Recent publications report the use of minimal accesses in cases of ruptured aneurysms, especially in cases of minor aneurysms and simple morphology 10,11 .…”

Section: Discussionmentioning

confidence: 99%

Suprapraorbital “key-hole” Approach for Surgical Treatment of Middle Cerebral Artery Aneurysms

Souza¹,

Flores²,

Roelke³

et al. 2018

jbnc

View full text Add to dashboard Cite

Objective. To describe details and technical difficulties observed in the use of this access for the treatment of middle cerebral artery aneurysms. Methods. This is a retrospective study including 15 patients with middle cerebral artery aneurysm operated on using this technique (two ruptured aneurysms and 13 incidental aneurysms). We considered age, gender, laterality of the aneurysm, and whether it was ruptured. We evaluated the surgical corridor (surgical field exposure and ease of handling of the surgical instruments), surgery time, complications, functional and cosmetic results. Results. This access provides adequate exposure of the surgical field, but the restricted working angle makes it difficult to dissect the aneurysm and, especially, to place the definitive clip. Conclusion. The restriction of the working angle may compromise the safety of the surgery. It is important to determine the specific indications for this access, particularly in cases of incidental aneurysms.Key words: Intracranial aneurysm; Supraorbital key-hole approach; Microsurgery . RESUMOObjetivo. Descrever pormenores e dificuldades técnicas observadas na utilização deste acesso para tratamento de aneurismas da artéria cerebral média. Métodos. Estudo retrospectivo de 15 doentes com diagnóstico de aneurisma da artéria cerebral média operados por esta técnica (2 aneurismas rotos e 13 incidentais). Consideramos idade, gênero, lateralidade do aneurisma, roto ou não roto. Realizamos avaliação do "corredor" cirúrgico (por meio da exposição do campo cirúrgico e conforto na manipulação de instrumentos cirúrgicos), duração do ato cirúrgico, complicações, resultado funcional pela "Glasgow outcome scale" (GOS) e cosmético. Resultados. Este acesso proporciona adequada exposição do campo cirúrgico, o ângulo de trabalho restrito dificulta a dissecção do aneurisma e, principalmente, a colocação do clipe. Conclusão. A restrição do ângulo de trabalho pode comprometer a segurança da cirurgia. É importante determinar as indicações especÍficas para este acesso, particularmente em casos de aneurisma incidentais.Palavras-chave: Aneurisma intracraniano; Acesso supraorbitário "key-hole"; Microcirurgia.

show abstract

“…The details of the operative techniques are described elsewhere. 30,33,34,42,43,[46][47][48] All keyhole clipping surgeries were performed by a senior author (K.M. ).…”

Section: Surgerymentioning

confidence: 99%

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

Mori

Wada

Otani

et al. 2017

Journal of Neurosurgery

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs. There were 62 cases in the nonfrail elderly group (mean age 72.9 ± 2.6 years [± SD]) and 198 cases in the nonelderly group (mean age 59.5 ± 7.6 years). The authors evaluated mortality and morbidity (modified Rankin Scale score > 2 or Mini-Mental State Examination [MMSE] score < 24) at 3 months and 1 year after the operation, the general cognitive function by MMSE at 3 months and 1 year, anxiety and depression by the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D) at 3 months, and radiological abnormalities and recurrence at 1 year. RESULTS Basic characteristics including comorbidities, frailty, and BDI and HAM-D scores were not significantly different between the 2 groups, whereas the MMSE score was slightly but significantly lower in the elderly group. Aneurysm location, largest diameter, type of keyhole surgery, neck clipping rate, and hospitalization period were not significantly different between the 2 groups. The incidence of chronic subdural hematoma was not significantly higher in the elderly group than in the nonelderly group (8.1% vs 4.5%, p = 0.332); rates of other complications including stroke and epilepsy were not significantly different. Lacunar infarction occurred in 3.2% of the elderly group and 3.0% of the nonelderly group. No patient in the elderly group required re-treatment or demonstrated recurrence of clipped aneurysms. The MMSE score at 3 months significantly improved in the nonelderly group but did not change in the elderly group. The BDI and HAM-D scores at 3 months were significantly improved in both groups. No patient died in either group. The morbidity at 3 months and 1 year in the elderly group (1.6% and 4.8%, respectively) was not significantly different from that in the nonelderly group (2.0% and 1.5%, respectively). CONCLUSIONS Keyhole clipping for nonfrail elderly patients with relatively small anterior circulation UIAs did not significantly increase the complication, mortality, or morbidity rate; hospitalization period; or aneurysm recurrence compared with nonelderly patients, and it was associated with improvement in anxiety and depression. Keyhole clipping to treat UIAs in the nonfrail elderly is an effective and long-lasting treatment.

show abstract

Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach

Cited by 32 publications

References 21 publications

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Keyhole Approach Combined With External Ventricular Drainage for Ruptured, Poor-Grade, Anterior Circulation Cerebral Aneurysms

Suprapraorbital “key-hole” Approach for Surgical Treatment of Middle Cerebral Artery Aneurysms

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

Contact Info

Product

Resources

About