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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Unilateral craniotomy for bilateral cerebral aneurysms
A Rajesh1, A Praveen, A K Purohit
1Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500 082, India. drarajesh1306@gmail.com
Summary
Selected patients with bilateral intracranial aneurysms can undergo successful clipping via a single unilateral craniotomy, avoiding staged procedures. This technique offers a safe approach for treating multiple anterior circulation aneurysms with good outcomes.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Multiple intracranial aneurysms in the anterior circulation typically require staged or bilateral craniotomies for treatment.
- A unilateral approach for bilateral aneurysms may reduce surgical morbidity.
Purpose of the Study:
- To present the technique and outcomes of clipping bilateral anterior circulation aneurysms through a unilateral craniotomy.
- To evaluate the safety and efficacy of this minimally invasive approach.
Main Methods:
- Retrospective analysis of 10 patients with bilateral supratentorial anterior circulation saccular aneurysms treated between 2006 and 2008.
- Unilateral orbito-pterional craniotomy performed from the side of the ruptured aneurysm.
- Clipping of all identified aneurysms in a single surgical sitting.
Main Results:
- Successfully clipped 23 aneurysms (12 contralateral) in 10 patients.
- Achieved good outcomes in 9 patients.
- Reported no mortality associated with the procedure.
Conclusions:
- The unilateral orbito-pterional approach is a safe and effective option for selected patients with bilateral supratentorial saccular aneurysms.
- Key surgical steps include ensuring brain laxity, wide basal cistern opening, and prioritizing clipping of the ruptured aneurysm.
