Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Department of Neurosurgery, Jaffna Teaching Hospital, Jaffna, Sri Lanka.
Br J Neurosurg. 2022 Jun;36(3):368-371. doi: 10.1080/02688697.2021.2005771. Epub 2021 Nov 24.
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.
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.
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.
Supraorbital micro-craniotomy is a safe approach for patients with proximal anterior circulation aneurysms, with low mortality and morbidity.
血管内技术对于脑动脉瘤越来越常见，但并非所有患者都适合，有些患者仍需要进行开颅手术。传统的翼点入路需要进行大骨瓣开颅，这本身就存在一定的发病率。随着对微创手术的期望越来越高，我们介绍了我们在良好分级的蛛网膜下腔出血患者中经眶上微型开颅夹闭动脉瘤的经验。
前瞻性收集通过该入路夹闭的良好分级蛛网膜下腔出血患者的数据。所有前循环部位的动脉瘤均包括在内，但不在可触及范围内的胼周动脉除外。在出院后 1 年以上对通过眶上入路夹闭动脉瘤的患者发送了一份长期随访问卷。
我们的结果显示，患者的死亡率为 1%，严重残疾率为 10%。与入路相关的并发症发生率较低，我们认为在所有病例中操作空间都没有受到限制。在出血时正在工作的患者中，有 70%的患者恢复了工作。
眶上微型开颅术是治疗近端前循环动脉瘤患者的一种安全方法，死亡率和发病率均较低。
