Keyhole Approaches Applied to Clipping of Acutely Ruptured Intracerebral Aneurysms—A Technical Note and Case Series

Evolution of keyhole techniques in aneurysm surgery allows for definitive surgical management of aneurysmal pathology with little disruption of normal surrounding tissue. While experienced vascular neurosurgeons are increasingly applying keyhole techniques to unruptured aneurysms, experience with ru...

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Published in:	World neurosurgery Vol. 168; pp. 209 - 218
Main Authors:	Mohale, Diapo Gerald, Naicker, Denver, Ndlovu, Blessing, Leola, Keletso, Dlamini, Makhosazana, Gardner, Brian, Gani, Raazik, Mukansi, Murimisi, Ouma, John Richard, Mpanza, Morena Nthuse, Profyris, Christos
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-12-2022
Subjects:	Aneurysm Aneurysm, Ruptured - diagnostic imaging Aneurysm, Ruptured - surgery Humans Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Keyhole Minipterional Neurosurgical Procedures - methods Retrospective Studies Rupture South Africa Subarachnoid Hemorrhage - diagnostic imaging Subarachnoid Hemorrhage - surgery Supraorbital Technical note Treatment Outcome South Africa Supraorbital Aneurysm Rupture MCA DCI mRS CT Technical note HIV PCOM Minipterional CSF Keyhole ICU SAH WFNS ACOM
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Summary:	Evolution of keyhole techniques in aneurysm surgery allows for definitive surgical management of aneurysmal pathology with little disruption of normal surrounding tissue. While experienced vascular neurosurgeons are increasingly applying keyhole techniques to unruptured aneurysms, experience with ruptured aneurysms is limited. We sought to explore technical nuances and present operative outcomes for our series of 40 consecutive patients presenting with ruptured intracerebral aneurysms treated with surgical clipping via a keyhole approach. This study is a consecutive, single-surgeon, single-center retrospective case series of aneurysms clipped with keyhole approaches at Helen Joseph Hospital in Johannesburg, South Africa. Patients presenting with subarachnoid hemorrhage were worked up exclusively with computed tomography. On the basis of vessel location and unique anatomic features, aneurysms were clipped through one of these approaches: minipterional, supraorbital, or keyhole interhemispheric. Operative details were assessed on retrospective file review, and patient outcomes were assessed on clinic follow-up. A minipterional approach was used for 55% of cases, the supraorbital approach in 30% of cases, and the mini-interhemispheric approach in 15% of cases. The intraoperative aneurysm rupture rate was 26.2%. Complete aneurysm occlusion was achieved in 97.4% with none of the 40 cases requiring conversion of a keyhole to a larger craniotomy. A good outcome was achieved for 72.5% of patients (modified Rankin Scale score ≤2). For patients presenting with World Federation of Neurological Surgeons grade I to III subarachnoid hemorrhage, 92.9% achieved a good outcome. The present series supports the concept that sound technical execution of keyhole approaches, even in the setting of acutely ruptured cerebral aneurysms, is a viable option for clipping of intracranial aneurysms.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1878-8750 1878-8769
DOI:	10.1016/j.wneu.2022.10.029