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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients
Justin M Caplan1, Kyriakos Papadimitriou, Wuyang Yang
1Department of Neurosurgery, Division of Cerebrovascular Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Background:
The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap.
Objective:
To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms.
Methods:
From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap.
Results:
The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients.
Conclusion:
The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.
Insights
The minipterional (MPT) craniotomy provides effective surgical access for unruptured anterior circulation aneurysms. This approach offers comparable results to standard pterional craniotomy with improved cosmetic outcomes and faster recovery.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Minimally Invasive Surgery
Background:
- Standard pterional craniotomy is effective for anterior circulation aneurysms but involves significant incision and muscle dissection.
- These factors can negatively impact patient recovery and cosmetic results.
- The minipterional (MPT) craniotomy presents a less invasive alternative with a shorter incision and reduced muscle dissection.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the minipterional (MPT) craniotomy for treating select unruptured anterior circulation aneurysms.
- To compare the MPT craniotomy with the traditional pterional approach in terms of surgical access, complications, and recovery.
Main Methods:
- A retrospective review of 72 patients who underwent 74 MPT craniotomies for 82 unruptured anterior circulation aneurysms between January 2009 and July 2013.
- Aneurysms were located in the middle cerebral artery, posterior communicating, paraophthalmic, choroidal, and dorsal ICA segments.
- The MPT craniotomy involved a hairline incision and a single myocutaneous flap.
Main Results:
- No operative corridors were compromised, and no craniotomy extensions were needed.
- The average length of hospitalization was 3.96 days, with minimal temporalis muscle wasting in 96% of patients.
- Three early complications included hematomas requiring evacuation and one MCA infarction; two patients needed reoperation for wound infections.
Conclusions:
- The minipterional (MPT) craniotomy is a viable alternative to the standard pterional craniotomy for specific unruptured anterior circulation aneurysms.
- It provides adequate surgical corridors and clip application without compromising outcomes.
- The MPT approach may lead to better cosmetic results and faster patient recovery.
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