Dzhindzhikhadze R S, Dreval' O N, Lazarev V A, Kambiev R L, Polyakov A V
Russian Medical Academy of Continuing Postgraduate Education, Moscow, Russia.
Inozemtsev City Clinical Hospital, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2019;83(3):93-101. doi: 10.17116/neiro20198303193.
The choice of an approach in surgery of bilateral multiple aneurysms is a complex and topical issue. According to the literature data, the occurrence rate of multiple aneurysms varies between 6.5 and 33%. Many authors have proposed various modern microsurgical approaches to reduce the risk of adverse surgical outcomes. The need for surgery in several vascular territories requires a detailed assessment of the topographo-anatomical relationships upon choosing a surgical approach. An important issue is preliminary planning and personalization of an approach for a particular patient.
We report a case of clipping of mirror middle cerebral artery aneurysms using a minimally invasive bilateral approach.
The presented case demonstrates successful clipping of middle cerebral artery aneurysms in different vascular territories using the bilateral supraorbital approach: a skin incision along the eyebrow followed by supraorbital keyhole craniotomy. Follow-up CT angiography in the postoperative period demonstrated elimination of aneurysms from the bloodstream. The cosmetic effect after the intervention was evaluated as excellent.
The bilateral supraorbital approach in surgery of multiple mirror aneurysms may be recommended as an alternative to the contralateral or bilateral pterional approach. The bilateral supraorbital approach avoids additional traction of the frontal lobes, provides a focused personalized approach, and is a safe and effective approach with excellent cosmetic results.
双侧多发性动脉瘤手术入路的选择是一个复杂且热门的问题。根据文献数据，多发性动脉瘤的发生率在6.5%至33%之间。许多作者提出了各种现代显微手术入路以降低手术不良后果的风险。在多个血管区域进行手术需要在选择手术入路时详细评估局部解剖关系。一个重要问题是针对特定患者的入路初步规划和个性化。
我们报告一例使用微创双侧入路夹闭镜像大脑中动脉动脉瘤的病例。
该病例展示了使用双侧眶上入路成功夹闭不同血管区域的大脑中动脉动脉瘤：沿眉毛做皮肤切口，随后进行眶上锁孔开颅术。术后随访CT血管造影显示动脉瘤从血流中消除。干预后的美容效果评估为极佳。
双侧眶上入路在多发性镜像动脉瘤手术中可作为对侧或双侧翼点入路的替代方法推荐。双侧眶上入路避免了额叶的额外牵拉，提供了一种有针对性的个性化入路，是一种安全有效的入路，美容效果极佳。
