Martinez-Perez Rafael, Joswig Holger, Tsimpas Asterios, Poblete Tomas, Albiña Pablo, Perales Ivan, Mura Jorge M
Department of Neurological Surgery, Wexner Medical Center, Ohio State University, 410 W 10th Ave, Columbus, OH, 43215, USA.
Division of Neurosurgery, Institute of Neurosciences, Universidad Austral de Chile, Valdivia, Chile.
Neurosurg Rev. 2020 Feb;43(1):361-370. doi: 10.1007/s10143-019-01219-9. Epub 2019 Dec 9.
Minipterional (MPT) craniotomy has recently been added to the neurosurgical armamentarium as a less invasive alternative to the pterional craniotomy for the treatment of parasellar lesions. However, its clinical applicability in the treatment of certain complex aneurysms, such as those arising in the paraclinoid region, remains unclear. To illustrate the microsurgical anatomy of a modified extradural MPT approach, which combines a classic MPT craniotomy with an extradural anterior clinoidectomy, and to demonstrate its clinical applicability in the treatment of complex paraclinoid aneurysms. A stepwise extradural MPT approach is illustrated in a cadaver study. Clinical outcome data from a series of 19 patients with 20 paraclinoid aneurysms treated surgically using the extradural MPT approach between 2016 and 2018 were retrospectively collected. In 95% of the cases, complete aneurysm occlusion was achieved. No aneurysm recurrences were seen during follow-up with a median length of 21 months. The outcome, according to the modified Rankin Scale, was 0 points in 12 patients (63%), 1 point in 6 patients (32%), and 2 points in 1 patient (5%). Four out of 6 patients (67%) with initial visual symptoms showed improvement following treatment, whereas in two (11%), vision became worse. The extradural MPT approach ensures a sufficiently large exposure of the paraclinoid region that is comparable with conventional approaches with the advantage of being minimally invasive. Our case series demonstrates the feasibility of this approach for the treatment of complex paraclinoid aneurysms.
近年来，翼点微创（MPT）开颅术已被纳入神经外科手术手段，作为一种侵入性较小的替代方法，用于治疗鞍旁病变的翼点开颅术。然而，其在治疗某些复杂动脉瘤（如发生在床突旁区域的动脉瘤）中的临床适用性仍不明确。为了阐述改良硬膜外MPT入路的显微外科解剖结构，该入路将经典的MPT开颅术与硬膜前床突切除术相结合，并展示其在治疗复杂床突旁动脉瘤中的临床适用性。在一项尸体研究中展示了逐步硬膜外MPT入路。回顾性收集了2016年至2018年间使用硬膜外MPT入路手术治疗的19例患者20个床突旁动脉瘤的临床结果数据。在95%的病例中，实现了动脉瘤的完全闭塞。在中位随访时间为21个月的随访期间，未观察到动脉瘤复发。根据改良Rankin量表，结果为12例患者（63%）评分为0分，6例患者（32%）评分为1分，1例患者（5%）评分为2分。6例初始有视觉症状的患者中有4例（67%）在治疗后症状改善，而2例（11%）视力变差。硬膜外MPT入路可确保对床突旁区域进行足够大的暴露，这与传统入路相当，且具有微创的优势。我们的病例系列证明了这种方法治疗复杂床突旁动脉瘤的可行性。
