title: Microsurgical Treatment of Posterior Cerebral Circulation Aneurysms Via Keyhole Approaches.
abstract: OBJECTIVE
  To explore the techniques of microsurgical treatment for posterior cerebral circulation aneurysms via keyhole approaches and assess its feasibility.
  
  
  METHODS
  A total of 27 patients with 28 posterior cerebral circulation aneurysms were treated surgically by keyhole approaches; 24 patients presented with subarachnoid hemorrhage and 3 with headache. Of these 27 patients, 15 patients were treated via the supraorbital keyhole approach, 6 via the retrosigmoid keyhole approach, 3 via the subtemporal keyhole approach, 2 via median suboccipital approach, and 1 via the pterional keyhole approach.
  
  
  RESULTS
  Of the 28 posterior cerebral circulation aneurysms, 24 aneurysms were clipped and 4 trapped; 23 aneurysms clipped completely, and 1 had residual aneurysm. Glasgow Outcome Scores at discharge revealed 25 patients had a good recovery; 1 patient was slightly disabled, and 1 patient was severely disabled. Of 15 patients treated via the supraorbital keyhole approach, to make a wider operative space, drilling of anterior clinoid process (2 patients) and posterior clinoid process (3 patients) was performed; posterior communicating artery was cut off (1 patient). For 3 patients with multiple aneurysms, complete occlusion was achieved via the same approach at one-stage.
  
  
  CONCLUSIONS
  Individualized keyhole approaches for posterior cerebral circulation artery aneurysms are safe and effective. The anterior clinoid process or posterior clinoid process could be drilled to offer a wide operative space for clipping. The use of multiple working windows is very helpful for controlling the parent artery and clipping the aneurysm.
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P. R. China. Electronic address: szlq006@163.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P. R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, P. R. China.
authors.forename: Guowei
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D061646:Operative Time; D020769:Posterior Cerebral Artery / Q000473:pathology / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Intracranial aneurysm; Keyhole approach; Posterior circulation