title: Surgical management of bilateral middle cerebral artery aneurysms via a unilateral supraorbital key-hole craniotomy.
abstract: BACKGROUND
  Surgical management of multiple intracranial aneurysms may be difficult if located bilaterally. In the case of bilateral middle cerebral artery (MCA) aneurysms, surgical treatment through a unilateral approach is generally not recommended. In this study we describe the surgical technique and important factors that enable treatment of bilateral MCA aneurysms via a unilateral key-hole approach.
  
  
  METHODS
  15 patients (12 females, 3 males) with bilateral aneurysms of the MCA were surgically treated via a supraorbital key-hole approach. Age ranged from 37 to 60 years (mean: 47). 7 of the 15 patients presented with an acute subarachnoid hemorrhage (SAH). Cerebral angiography was performed in all patients pre- and postoperatively. Patients suffering from SAH were treated within the first 72 h. All 15 patients were planned to be operated via a unilateral supraorbital keyhole craniotomy using an eye-brow incision.
  
  
  RESULTS
  In 10 of the 15 patients MCA aneurysms of both sides could be occluded completely through the unilateral approach. In 5 patients bilateral craniotomies had to be performed, in 1 of these patients during the same procedure. Factors necessitating a second craniotomy were brain swelling (1 patient with SAH), insufficient instruments (2 patients), and complex configuration of the contralateral aneurysm (2 patients). Permanent morbidity was anosmia in 1 patient and hyposmia and a mild visual field deficit in 1 further patient.
  
  
  CONCLUSIONS
  Bilateral aneurysms of the MCA may be treated sufficiently through a unilateral supraorbital key-hole approach in selected patients. This is also possible in patients presenting with SAH. Factors necessitating bilateral craniotomies were brain swelling and complex configuration of the contralateral aneurysm.
authors: Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, 70174 Stuttgart, Germany. n.hopf@klinikum-stuttgart.de
authors: N J
authors: NJ
authors: Hopf
authors: A
authors: A
authors: Stadie
authors: R
authors: R
authors: Reisch
mesh_terms: D000328:Adult; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery; D016896:Treatment Outcome