Treatment outcomes of 1-stage clipping of multiple unruptured intracranial aneurysms via keyhole approaches

Abstract

OBJECTIVE Complete exclusion of multiple unruptured intracranial aneurysms (UIAs) in one session of intervention may be ideal. However, such situations are not always feasible in terms of treatment modalities and outcomes. The authors aimed to analyze their experience with 1-stage clipping of multiple UIAs. METHODS Medical records between March 2013 and December 2018 were retrospectively reviewed, and 111 1-stage keyhole approaches in 110 patients with 261 multiple UIAs were ultimately included in this study. Clinical and radiological outcomes were analyzed, as well as postoperative complications up to 1 month after the surgery and their risk factors. RESULTS Keyhole approaches included unilateral supraorbital in 87 operations (78.4%), bilateral supraorbital in 12 (10.8%), and others in 12. The mean operative duration was 169.6 minutes (range 80–490 minutes). The highest numbers of aneurysms clipped at once were 2 (73.9%) and 3 (18.9%). Complete exclusion and residual neck of the clipped aneurysms were achieved in 89.3% and 7.3%, respectively. There was no significant difference between pre- and postoperative 1-month neurological states (p = 0.14). The permanent morbidity rate was 1.8% (n = 2), and there were no deaths. Postoperative transient neurological deterioration (TND) with no radiological and electrophysiological abnormalities occurred in 8 operations (7.2%). Hypertension was the only significant risk factor for postoperative TND (adjusted odds ratio 17.03, 95% confidence interval 1.99–2232.24, p = 0.01). CONCLUSIONS One-stage clipping of multiple UIAs via keyhole approaches showed satisfactory treatment outcomes with a low permanent morbidity. Patients with chronic hypertension had a high risk of postoperative TND.

Microsurgical Clipping of Unruptured Anterior Circulation Aneurysms—A Global Multicenter Investigation of Perioperative Outcomes

“…However, with respect to neurological deterioration at discharge, these parameters did not reach statistical significance and are in line with the results of smaller series. 29,30 Presumably, the risks of simultaneous clipping of multiple aneurysms are additive, and it can be assumed that this additive effect is similar to the risk of a 2-stage procedure and the then respective risks of the individual operations.…”

Application of zone classification in multiple intracranial aneurysmal subarachnoid hemorrhage treatment strategies

“…Seo et al [ 14 ] found that one-stage multiple craniotomies for MIAs was safe and economical. Hong et al [ 15 ] also demonstrated that one-stage clipping of MIAs showed satisfactory treatment outcomes. Andic et al [ 16 ] believed that one-stage MIA treatment with combined endovascular techniques was technically feasible but that its safety due to relatively high complication rates remained controversial (i.e., because unruptured tiny aneurysms weighted the low annual spontaneous rupture rate and potential surgical risks) [ 17 ].…”

Effects of Scalp Nerve Block on the Quality of Recovery after Minicraniotomy for Clipping of Unruptured Intracranial Aneurysms : A Randomized Controlled Trial

“…Furthermore, significant differences in surgical duration between the two groups could affect the QoR in the early postoperative period. Compared to conventional craniotomy, minicraniotomy generally has the advantage of reducing intraoperative loss of cerebrospinal fluid and blood as surgical duration is about half as short [ 8 , 16 , 27 , 28 ]. However, long surgical duration in the SNB group may have offset these advantages of minicraniotomy, causing greater discomfort and hindering early ambulation after surgery, and may have ultimately counterbalanced the benefits of SNB on postoperative QoR [ 31 , 38 ].…”

“…The surgical approach for clipping of UIAs was based on the location and direction of the aneurysms, spatial relationship among the aneurysms, brain parenchyma, and bony structures, and neurosurgeon’s preference. Four types of keyhole minicraniotomy were considered : supraciliary supraorbital, frontolateral supraorbital, lateral supraorbital, and minipterional approaches [ 8 , 16 ]. Surgical complications, including intraoperative premature aneurysmal rupture and postoperative stroke with neurological deficit, were recorded if present.…”