Surgical Technique for Aneurysms at the A3 Segment of Anterior Cerebral Artery Via Anterior Interhemispheric Keyhole Approach.
OBJECTIVE
Traditional craniotomies for treatment of the aneurysms at the A3 segment of anterior cerebral artery (A3As), such as frontal approach and interhemispheric approach, require pre-hairline incision and relatively long incision, extensive bone flap, inevitable supraorbital nerve injury, opening frontal sinus, and increased operative time. Here we reported anterior interhemispheric keyhole approach with minimally invasive advantages for treatment of A3As.


METHODS
Thirteen A3As and one A1 aneurysm in thirteen patients were confirmed by computed tomographic angiography (CTA) and/or digital subtraction angiography (DSA). All patients underwent anterior interhemispheric keyhole approach with a hairline incision across the midline and a bone flap 3-4 cm in diameter, combined with external ventricular drainage, neuronavigation, intraoperative neurophysiological monitoring (IONM), and transcranial Doppler (TCD). Clinical characteristics and therapeutic results of the patients were analyzed, and the postoperative functional capacities of those patients were evaluated using Glasgow Outcome Scale (GOS) six months later.


RESULTS
All aneurysms were successfully obliterated via the anterior interhemispheric keyhole approach combined with external ventricular drainage. Mean duration of surgery (from skin incision to wound closure) was 100 minutes with a range of 70 to 135 minutes. No severe interhemispheric keyhole approach related complications, postoperative infections, secondary intracranial haemorrhage, severe cerebral vasospasm, and aneurysmal neck remnants were detected. Median hospital stay after surgery was 9.0 days (range 8 to 11 days). And the postoperative functional capacities evaluated by GOS were normal six months later.


CONCLUSIONS
The anterior interhemispheric keyhole approach combined with external ventricular drainage is a safe, effective, and minimally invasive craniotomy technique for the treatment of A3 aneurysms.
The First Affiliated Hospital of Fujian Medical University, Department of Neurosurgery, China.
Shu-Fa
SF
Zheng
Pei-Sen
PS
Yao
Liang-Hong
LH
Yu
De-Zhi
DZ
Kang
D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D038361:Neuronavigation; D011183:Postoperative Complications / Q000601:surgery; D016896:Treatment Outcome