Supraorbital keyhole approach for anterior circulation aneurysms

Tang, Chao; Sun, Jun; Hou, Xue; Yan, Yu; Xing, Feng

doi:10.5137/1019-5149.jtn.6160-12.1

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…There was no statistically significant difference in the mRS between the two groups ( P = 0.137), similar to a previous study by Park and Park (2). The reason there was no difference between the two approaches is because although the skin incision, craniotomy size, and dura openings are different, both of the approaches use the standard microsurgical procedure to clip the aneurysm (14), as mentioned earlier.…”

Section: Discussionmentioning

confidence: 99%

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A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms

Genesan

Haspani²,

Noor³

2018

MJMS

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BackgroundMany different conventional approaches such as the frontal and pterional approaches are used to access anterior circulation aneurysms. Recently, the supraorbital approach has been widely applied to the treatment of anterior circulation aneurysms. This study was done to evaluate which approach (pterional or supraorbital) has better outcomes in terms of residual neck post-clipping, cosmetic satisfaction, scar tenderness, complications and functional outcomes.MethodologyA total of 123 patients were recruited into this study, comprising 82 patients who underwent a pterional approach and 41 patients who underwent a supraorbital approach. Computed tomography angiograms, the modified Rankin Scale, and the visual analogue scale were administered at 6 months to look for residual aneurysm, functional outcomes, scar tenderness, and cosmetic satisfaction. Complication data were collected from patients’ case notes.ResultsThe mean operating time for the pterional group was 226 min, compared to supraorbital group, which was 192 min (P = 0.07). Cosmetic satisfaction was significantly higher (P = 0.001) in the supraorbital group. There was no significant difference between the supraorbital and pterional groups’ scar tenderness (P = 0.719), residual aneurysm (P = 0.719), or functional outcomes (P = 0.137), and there was no significant difference between the groups in terms of intra-operative and post-operative complications.ConclusionsThe supraorbital group had better cosmetic outcomes and shorter operating times compared to the pterional group.

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Section: Discussionmentioning

confidence: 99%

“…There was only one patient in each group that developed frontal numbness. During the skin incision using the supraorbital approach, the incision remains superficial to avoid injury to the supraorbital nerve (14).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms

Genesan

Haspani²,

Noor³

2018

MJMS

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“…Tang et al [ 82 ] described the modified supraorbital keyhole approach which is started with a skin incision made into the skin crease or the eyebrow and creating a fronto-sphenoidal craniotomy.…”

Section: Resultsmentioning

confidence: 99%

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Candy,

Van Der Veken,

Van Velthoven

2024

Acta Neurochir

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Background The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology. Already described in the beginning of the twentieth century and perfected by Yasargil in the 1970s, it has seen many modifications. These modifications have been a normal evolution for most neurosurgeons, tailoring the craniotomy to the patients’ specific anatomy and pathology. Nonetheless, an abundance of variations have appeared in the literature. Methods A search strategy was devised according to the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. To identify articles investigating the variations in the pterional approach, the following search terms were applied: (pterional OR minipterional OR supraorbital) AND (approach OR craniotomy OR technique). Results In total, 3552 articles were screened with 74 articles being read in full with 47 articles being included for review. Each article was examined according the name of the technique, temporalis dissection technique, craniotomy technique and approach. Conclusion This systematic review gives an overview of the different techniques and modifications to the pterional craniotomy since it was initially described. We advocate for the use of a more standardised nomenclature that focuses on the target zone to simplify the management approach to supratentorial aneurysms.

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“…The supraorbital keyhole (SOK) surgery provides adequate aneurysmal access while minimizing trauma to the surrounding structures, including the skin, bone, dura, and, most importantly, the brain,[ 5 ] yet not applicable to all PcA.…”

Section: Introductionmentioning

confidence: 99%

“…[6,8] PcA clipping mostly requires anterior clinoidectomy, optic canal opening, and resection of the dural ring, therefore standard or modified pterional approach including the Dolenc skull base technique is preferable; however, a subset of PcA can be clipped through minimal invasive keyhole mini-craniotomy. [11] e supraorbital keyhole (SOK) surgery provides adequate aneurysmal access while minimizing trauma to the surrounding structures, including the skin, bone, dura, and, most importantly, the brain, [5] yet not applicable to all PcA.…”

Section: Introductionmentioning

confidence: 99%

Supraorbital keyhole approach for paraclinoid aneurysms clipping: A case series with literature review

Abdulateef

Morita

Ismail

et al. 2023

Surgical Neurology International

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Background: Paraclinoid aneurysms (PcAs) are challenging aneurysms due to the complexity of their relation to the surrounding bony and neurovascular structures. Although over the past decade, their management strategy has shifted from transcranial to endovascular approaches; here, we try to revolve around a subcategory to which minimal invasive supraorbital keyhole (SOK) surgery is feasible depending on specific radiological criteria with a literature review. Methods: A group of unruptured PcAs was managed surgically, with a subset that was clipped through the SOK approach. They were selected by preoperative simulation images using 3D computed tomography (CT) angiography (CTA). We also conducted an extensive literature review based on a database available on PubMed and Google Scholar, the yielded cases from the literature review plus our cases were analyzed according to six parameters including their size, location, dome direction, need for clinoidectomy and proximal cervical control, and surgical outcome. Results: From February 2009 to August 2022, 49 cases of unruptured PcAs were managed by clipping, and of these, four cases were clipped by the SOK approach, in addition, four cases were yielded through the literature review. The sizes of the PcAs ranged from 3 to 8 mm. Their location fluctuated from anterior to the superomedial wall and their domes pointed superiorly except for one which points posteriorly. Six of eight cases required anterior clinoidectomy, the outcome was uneventful. Conclusion: A subset of unruptured PcAs are amenable to SOK with criteria such as unruptured small aneurysm (<10 mm) and projected superiorly. These characteristics can be determined preoperatively using CTA.

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Supraorbital keyhole approach for anterior circulation aneurysms

Cited by 9 publications

References 6 publications

A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms

A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms

‘What’s in a name’, a systematic review of the pterional craniotomy for aneurysm surgery and its many modifications with a proposal for simplified nomenclature

Supraorbital keyhole approach for paraclinoid aneurysms clipping: A case series with literature review

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