title: [Effects of supraorbital keyhole approach upon the clipping of distal basilar artery aneurysms].
abstract: OBJECTIVE
  To explore the feasibility and efficacy of supraorbital keyhole approach (SOKA) for the clipping of distal basilar artery (BA) aneurysms.
  
  
  METHODS
  A total of 12 patients with distal BA aneurysms were treated with SOKA. All patients had subarachnoid hemorrhage (SAH). They underwent surgeries for an average of 7.6 days post-SAH (n = 2, within 24 hours; n = 7, 3 - 14 days; n = 2, 2 week later). Aneurysms were located on BA (n = 10), posterior cerebral artery (PCA) 1-2 segment (n = 1) and PCA 2 segment (n = 1). One-stage operations were performed in 2 cases with BA bifurcation aneurysm accompanied with anterior cerebral artery (ACA) 1 segment aneurysm and multiple middle cerebral artery (MCA) aneurysms respectively. Anterior and posterior clinoid process was drilled off in 2 patients respectively to increase the room for maneuver. Posterior communicating artery was cut in one case to expand the working space. Once a balloon catheter was put into BA, proximal artery control was implemented if immature aneurysm rupture occurred.
  
  
  RESULTS
  All distal BA aneurysms were completely clipped; 3 accompanied aneurysms were clipped together through single supraorbital keyhole approach. One aneurysm ruptured intra-operatively and was clipped successfully with temporary parent arterial occlusion. No conscious disturbance and dyskinesia occurred post-operatively for all patients.
  
  
  CONCLUSIONS
  During the procedure of SOKA, anterior and posterior clinoidectomy may be applied to increase the working space. Distal BA aneurysms located less than 15 mm higher over anterior skull base can be effectively treated via SOKA.
authors.affiliation: Department of Neurosurgery, Soochow University, Suzhou, China. szlq006@yahoo.com.cn
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
authors.forename: Yu-yuan
authors.initials: YY
authors.lastname: Ma
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome