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Peruvian Journal of Neurosurgery
Mini-pterional craniotomy for clipping of anterior circulation Aneurysms
JERSON FLORES C, ALFREDO FUENTES-DAVILA M †, WESLEY ALABA G.Abstract (Spanish) || Full Text || PDF (Spanish)
Objectives: The pterional approach is the most common approach in vascular neurosurgery, but in recent years has been an increasing interest in minimally invasive surgery or keyhole surgery. We present preliminary results from the use of Mini-pterional Craniotomy in surgery for cerebral aneurysms performed in the Cayetano Heredia Hospital in 2009.
Methods: We performed a Mini-pterional Craniotomy of 2.5 x 3 cm from a curved incision of approximately 5-6 cm behind the hairline and centered on the orbitofrontal and posterior aneurysm clipping, in patients with PComA, bifurcation ICA and MCA aneurysms, during the late period, Hunt and Hess I-III, without edema, vasospasm or associated hematoma.
Results: From January to December 2009 six patients were operated by Mini-pterional Craniotomy, 4 with PComA aneurysms (66%), 1 with ICA (17%) and 1 with MCA (17%). All were operated on late and Hunt and Hess was I in 3 cases (50%) III in 2 cases (33%) and II (17%). There were no operative complications and the outcome was favorable in most cases: Rankin 1 (50%) and Rankin 2 (33%).
Conclusions: Mini-pterional Craniotomy is a minimally invasive surgery for brain aneurysms, which maintains the advantages of the standard pterional approach, but it minimizes the exposure of brain parenchyma and soft tissue manipulation. It is a valid surgical alternative in selected cases, mainly from PComA and MCA aneurysms.
Key words: Intracranial Aneurysm, Craniotomy, Minimally Invasive Surgical Procedures. (source: MeSH NLM)