Microsurgical experience with keyhole operations on intracranial aneurysms.
BACKGROUND
We report our experience with keyhole approaches as favorable treatments for various intracranial aneurysms including multiple aneurysms and giant aneurysms.


METHODS
According to the different locations of 105 aneurysms harbored in 100 patients, different keyhole approaches were designed elaborately, among which a supraorbital keyhole approach was used in 91 cases, a pterional keyhole approach in 5 cases, a subtemporal keyhole approach in 3 cases, a retromastoid keyhole approach in 2 cases, and a unifrontal interhemispheric keyhole approach in 1 case.


RESULTS
Among those 105 aneurysms, 99 were clipped successfully, including 4 that were resected after clipping. One mini-aneurysm was wrapped. The other aneurysms were trapped, including 1 VA aneurysm, 1 giant ICA aneurysm, 1 giant PCoA aneurysm, and 2 giant aneurysms in the PCAs (P2-P3 segment). Multiple aneurysms in 5 cases were treated in 1 surgical session, including 3 cases via unilateral approaches and 2 cases via bilateral approaches. There were no severe keyhole approach-related complications in this present series.


CONCLUSIONS
The keyhole approaches, based on improvements in diagnostic imaging, advanced surgical instruments, and microsurgical skills, are effective and ideal craniotomy techniques in the hands of experienced neurosurgeons for the treatment of intracranial aneurysms, including multiple and giant aneurysms, in patients without diffuse SAH, severe cerebral vasospasm, and severe brain edema or brain swelling.
Lan
Qing
Q
Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215004, PR China. szlqz@pub.sz.jsinfo.net
Gong
Zhigang
Z
Kang
Dezhi
D
Zhang
Hengzhu
H
Qian
Zhiyuan
Z
Chen
Jian
J
Huang
Qiang
Q
D000293:Adolescent; D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D005138:Eyebrows; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D044583:Neuroendoscopy; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome