title: Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy: maximizing symptomatic resolution and minimizing surgical invasiveness.
abstract: OBJECTIVE
  For oculomotor nerve palsy (ONP) induced by unruptured posterior communicating artery (PCoA) aneurysms, the authors performed surgical clipping via a superciliary keyhole approach as an optimal treatment modality with high efficiency and low invasiveness. In this study, they then evaluated the technical feasibility, safety, clinical outcomes, including recovery from ONP as well as cosmetic results, and durability of the procedure.
  
  
  METHODS
  Thirteen patients presenting with complete (7 patients) or incomplete (6 patients) ONP underwent surgery via a superciliary approach. The operative video record was used to evaluate the technical feasibility, neurological examinations and CT were performed to analyze the safety of the treatment, and neuroophthalmological examinations and 3D CT angiography were undertaken to determine the effectiveness and durability of the treatment.
  
  
  RESULTS
  In all cases, the aneurysms were successfully clipped using a 3.5-cm eyebrow incision and supraorbital minicraniotomy. The mean operative time was 108 ± 24 minutes. Twelve (92.3%) of the 13 patients showed complete resolution of the ONP. All 6 patients (100%) with incomplete ONP recovered completely within 1-2 months after surgery, whereas 6 (85.7%) of the 7 patients with complete ONP recovered completely within 1-6 months after surgery. Cosmetic results for the operative wounds were excellent without frontalis palsy. The durability of the treatment was ascertained based on 3D CT angiograms obtained 1 year after surgery.
  
  
  CONCLUSIONS
  Surgical clipping via a superciliary keyhole approach can be an optimal treatment modality for PCoA aneurysms inducing ONP because it is effective, safe, and durable.
authors.affiliation: Department of Neurosurgery, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea. jparkneurosurgery@gmail.com
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Bo-Young
authors.initials: BY
authors.lastname: Chun
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D015840:Oculomotor Nerve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome