Department of Neurosurgery, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Clin Neurol Neurosurg. 2024 Apr;239:108230. doi: 10.1016/j.clineuro.2024.108230. Epub 2024 Mar 3.
Traditional large craniotomies have been the standard for aneurysm surgery. However, minimally invasive "keyhole" approaches have gained popularity for aneurysm clipping in recent years. This study focuses on Supra-Orbital Keyhole Approach (SOKHA),its use in clipping of aneurysms of the anterior Circle of Willis. Here we share the experiences of a tertiary care center regarding aneurysm clipping using SOKHA.
We retrospectively reviewed 166 cases involving aneurysm clipping, with 62 patients undergoing SOKHA and 104 patients undergoing the pterional approach. Factors evaluated included patient demographics, aneurysm characteristics, incidence of intraoperative complications, temporary-clipping usage, and postoperative clinical outcomes. Glasgow Outcome Scale scores were utilized to assess clinical outcomes.
The study found that both the SOKHA and pterional approaches were similar in terms of age distribution, Hunt and Hess grades, and the incidence of hydrocephalus. The majority of aneurysms in both groups were anterior communicating artery aneurysms.Hydrocephalus was observed in 14.5 % of SOKHA cases and 13.5 % of pterional cases. Intraoperative aneurysm rupture occurred in 8.1 % of SOKHA cases and 7.7 % of pterional cases. There were no mortalities in the SOKHA group, while the pterional group had 1.92 % mortality rate. At the last follow-up, 77.4 % of SOKHA cases and 75.9 % of pterional cases had a favorable outcome (Glasgow Outcome Scale IV and V), with no significant difference.
SOKHA offers the advantage of potential cosmetic benefit with neurological outcomes comparable to those of the traditional pterional approach, in properly selected patients.
传统的大骨瓣开颅术一直是动脉瘤手术的标准方法。然而，近年来微创的“锁孔”方法在动脉瘤夹闭中越来越受欢迎。本研究关注的是眶上锁孔入路（SOKHA），及其在Willis 前环动脉瘤夹闭中的应用。在这里，我们分享一家三级护理中心使用 SOKHA 进行动脉瘤夹闭的经验。
我们回顾性分析了 166 例动脉瘤夹闭病例，其中 62 例患者采用 SOKHA，104 例患者采用翼点入路。评估的因素包括患者人口统计学、动脉瘤特征、术中并发症发生率、临时夹闭使用情况和术后临床结果。格拉斯哥预后量表（GOS）评分用于评估临床结果。
研究发现，SOKHA 和翼点入路在年龄分布、Hunt 和 Hess 分级以及脑积水发生率方面相似。两组中大多数动脉瘤都是前交通动脉动脉瘤。SOKHA 组有 14.5%的患者出现脑积水，翼点组有 13.5%的患者出现脑积水。SOKHA 组有 8.1%的患者术中发生动脉瘤破裂，翼点组有 7.7%的患者术中发生动脉瘤破裂。SOKHA 组无死亡病例，而翼点组有 1.92%的死亡率。末次随访时，SOKHA 组 77.4%的患者和翼点组 75.9%的患者预后良好（GOS 量表 IV 和 V），差异无统计学意义。
在适当选择的患者中，SOKHA 具有潜在美容优势，其神经功能结果可与传统翼点入路相媲美。
