Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurosurgery, New York University, New York, New York, USA.
World Neurosurg. 2022 Oct;166:e799-e807. doi: 10.1016/j.wneu.2022.07.107. Epub 2022 Aug 1.
The lateral supraorbital (LSO) approach is a minimally invasive modification of the standard pterional approach to anterior circulation aneurysms. This study aimed to describe a dual-trained cerebrovascular neurosurgeon's first 18-month experience with the LSO approach, including decision-making criteria and lessons learned.
This retrospective case series analyzed 50 consecutive patients treated with LSO craniotomy for aneurysm clipping by a single surgeon. Aneurysms were separated into 3 categories by location: internal carotid artery, anterior communicating artery, and middle cerebral artery. Surgical characteristics were evaluated for differences by location and rupture status.
Aneurysm clipping via LSO was performed on 57 aneurysms in 50 patients. Fixed retraction was employed less often in patients with internal carotid artery aneurysms than in patients with anterior communicating artery, middle cerebral artery, or multiple aneurysms (10% vs. 68.2%, 45.5%, and 42.9, P = 0.02). Of patients, 26 (52%) presented with subarachnoid hemorrhage; the majority of patients (92.3%) had Hunt and Hess grade I-III. No differences were noted in intraoperative rupture rates, fixed retractor use, operative duration, or estimated blood loss by rupture status. Adverse events included permanent frontalis nerve palsy in 1 patient (2%), temporalis atrophy in 1 patient, and transient aphasia in 1 patient. No postoperative hematomas or strokes were observed.
The LSO approach can safely and effectively treat anterior circulation aneurysms and should be considered a viable minimally invasive option for aneurysm clipping. Further studies comparing the LSO approach with other cranial approaches are needed.
外侧眶上（LSO）入路是对标准翼点入路治疗前循环动脉瘤的一种微创改良。本研究旨在描述一位双重训练的脑血管神经外科医生在 LSO 入路的头 18 个月的经验，包括决策标准和经验教训。
本回顾性病例系列分析了由一位外科医生通过 LSO 开颅术治疗的 50 例连续患者的病例。根据位置将动脉瘤分为 3 类：颈内动脉、前交通动脉和大脑中动脉。根据位置和破裂状态评估手术特征的差异。
通过 LSO 进行了 57 个动脉瘤的夹闭手术，涉及 50 名患者。与前交通动脉、大脑中动脉或多发性动脉瘤患者相比，颈内动脉动脉瘤患者较少使用固定牵开器（10%比 68.2%、45.5%和 42.9%，P=0.02）。26 名患者（52%）出现蛛网膜下腔出血；大多数患者（92.3%）的 Hunt 和 Hess 分级为 I-III 级。根据破裂状态，术中破裂率、固定牵开器使用、手术时间或估计失血量均无差异。不良事件包括 1 例患者（2%）出现永久性额神经麻痹、1 例患者出现颞肌萎缩和 1 例患者出现短暂性失语。未观察到术后血肿或中风。
LSO 入路可以安全有效地治疗前循环动脉瘤，应被视为一种可行的微创夹闭动脉瘤的选择。需要进一步研究比较 LSO 入路与其他颅入路。
