Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms.
BACKGROUND
We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation.


METHODS
A prospective review of all patients who underwent operations to clip aneurysms in Newcastle between 1993 and 2002.


RESULTS
Fifty-six aneurysms were clipped via minicraniotomy in 47 patients. Six patients presented with acute subarachnoid hemorrhage (SAH), 40 patients were admitted for elective clipping, and 1 patient presented with an SAH, had the responsible aneurysm clipped and was readmitted later for elective clipping of a further aneurysm. Bilateral supraorbital craniotomies were performed in 3 patients. In 6 patients, multiple aneurysms were clipped via a single craniotomy. All aneurysms were well visualized with the microscope. Endoscopic assistance was not found necessary. All were successfully clipped. Two aneurysms ruptured while being clipped. There was no direct mortality from surgery. One patient died later from a separate posterior circulation aneurysm. One patient had a significant long-term deficit but remained independent, and 1 had 3 seizures over the 12 months after surgery. This represents a 4% morbidity at 1 year.


CONCLUSIONS
Selected anterior cerebral circulation aneurysms can be clipped with low morbidity, using an ipsilateral minicraniotomy preserving the orbital rim, and without using an endoscope. The types of aneurysm selection criteria and operative equipment used are described.
Mitchell
Patrick
P
Department of Neurosurgery, Newcastle General Hospital, NE4 6BE Newcastle, UK. patick.mitchell@ncl.ac.uk
Vindlacheruvu
R R
RR
Mahmood
Khalid
K
Ashpole
Richard D
RD
Grivas
Athanasios
A
Mendelow
A David
AD
D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy / Q000706:statistics & numerical data; D005138:Eyebrows / Q000033:anatomy & histology; D005260:Female; D005624:Frontal Bone / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology / Q000473:pathology; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D009017:Morbidity; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D013525:Surgical Instruments / Q000592:standards; D016896:Treatment Outcome