title: Cranio-orbital approach for complex aneurysmal surgery.
abstract: Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.
authors.affiliation: Department of Neurosurgery, Cork University Hospital, Cork, Eire.
authors.forename: M O
authors.initials: MO
authors.lastname: Kelleher
authors.forename: M H
authors.initials: MH
authors.lastname: Kamel
authors.forename: M G J
authors.initials: MG
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011446:Prospective Studies; D019291:Skull Base / Q000601:surgery