Gopiga Thanabalasundaram1, Wai Cheong Soon1, Athiththan Ponnampalam2, Howard L Brydon3. 1. Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK. 2. Department of Neurosurgery, Jaffna Teaching Hospital, Jaffna, Sri Lanka. 3. Department of Neurosurgery, University Hospital of North Midlands, Staffordshire, UK.
Abstract
BACKGROUND: Endovascular techniques are becoming more common for cerebral aneurysms, but not all patients are suitable and open surgery is necessary for some. The traditional pterional approach requires a large craniotomy and this carries some morbidity in itself. With the growing expectation for minimally invasive surgery, we present our experience in supraorbital mini-craniotomy for good grade aneurysmal subarachnoid haemorrhage. METHODS: Data on good-grade subarachnoid haemorrhage patients having aneurysms clipped via this approach were collected prospectively. Aneurysms at all anterior circulation sites were included, with the exception of the pericallosal artery, which was not within reach. A long-term follow-up questionnaire was sent to patients who had a supraorbital approach to clip the aneurysm at more than 1 year from hospital discharge. RESULTS: Our results demonstrate mortality of 1% and severe residual disability in 10% of patients. Approach-related complications were low and it was considered that the operating space was not restricted in any of our cases. Return to work was achieved in 70% of patients who were working at the time of their haemorrhage. CONCLUSIONS: Supraorbital micro-craniotomy is a safe approach for patients with proximal anterior circulation aneurysms, with low mortality and morbidity.
BACKGROUND: Endovascular techniques are becoming more common for cerebral aneurysms, but not all patients are suitable and open surgery is necessary for some. The traditional pterional approach requires a large craniotomy and this carries some morbidity in itself. With the growing expectation for minimally invasive surgery, we present our experience in supraorbital mini-craniotomy for good grade aneurysmal subarachnoid haemorrhage. METHODS: Data on good-grade subarachnoid haemorrhage patients having aneurysms clipped via this approach were collected prospectively. Aneurysms at all anterior circulation sites were included, with the exception of the pericallosal artery, which was not within reach. A long-term follow-up questionnaire was sent to patients who had a supraorbital approach to clip the aneurysm at more than 1 year from hospital discharge. RESULTS: Our results demonstrate mortality of 1% and severe residual disability in 10% of patients. Approach-related complications were low and it was considered that the operating space was not restricted in any of our cases. Return to work was achieved in 70% of patients who were working at the time of their haemorrhage. CONCLUSIONS: Supraorbital micro-craniotomy is a safe approach for patients with proximal anterior circulation aneurysms, with low mortality and morbidity.