Potential Risks and Limited Indications of the Supraorbital Keyhole Approach for Clipping Internal Carotid Artery Aneurysms.
World Neurosurg X
; 2: 100025, 2019 Apr.
Article
in En
| MEDLINE
| ID: mdl-31218296
ABSTRACT
BACKGROUND:
Internal carotid artery (ICA) aneurysm may be a good target for supraorbital keyhole clipping. We discuss the surgical indications and risks of keyhole clipping for ICA aneurysms based on long-term clinical and radiologic results.METHODS:
This was a retrospective analysis of 51 patients (aged 35-75 years, mean 62 years) with ICA aneurysms (mean 5.8 ± 1.8 mm) who underwent clipping via the supraorbital keyhole approach between 2005 and 2017. Neurologic and cognitive functions were examined by several methods, including the modified Rankin Scale and Mini-Mental Status Examination. The state of clipping was assessed 1 year and then every few years after the operation.RESULTS:
Complete clipping was confirmed in 45 patients (88.2%), dog-ear remnants behind the clip persisted in 4 patients, and wrapping was performed in 2 patients. Mean duration of postoperative hospitalization was 3.4 ± 6.9 days. The mean clinical follow-up period was 6.6 ± 3.2 years. The overall mortality was 0, and overall morbidity (modified Rankin Scale score ≥2 or Mini-Mental Status Examination <24) was 3.9%. Completely clipped aneurysms did not show any recurrence during the mean follow-up period of 6.3 ± 3.1 years, but the 2 (3.9%) aneurysms with neck remnants showed regrowth.CONCLUSIONS:
The risk of neck remnant behind the clip blade is a drawback of supraorbital keyhole clipping. The surgical indication requires preoperative simulation and careful checking of the clip blade state is essential.
3D, 3-Dimensional; AcomA, Anterior communicating artery; AntChoA, Anterior choroidal artery; BDI, Beck Depression Inventory; CT, Computed tomography; CTA, Computed tomography angiography; Clipping; DSA, Digital subtraction angiography; DWI, Diffusion-weighted imaging; HAM-D, Hamilton Depression Scale; HDS-R, Revised Hasegawa Dementia Scale; ICA, Internal carotid artery; ISUIA, International Study of Unruptured Intracranial Aneurysms; Internal carotid artery; Keyhole surgery; MCA, Middle cerebral artery; MMSE, Mini-Mental Status Examination; MRI, Magnetic resonance imaging; NIHSS, National Institutes of Health Stroke Scale; PcomA, Posterior communicating artery; UCA, Unruptured cerebral aneurysm; Unruptured cerebral aneurysm; mRS, Modified Rankin Scale
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Etiology_studies
/
Risk_factors_studies
Language:
En
Journal:
World Neurosurg X
Year:
2019
Document type:
Article
Affiliation country: