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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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The supraorbital endoscopic approach for aneurysms.

Robert Reisch1, Gerrit Fischer2, Axel Stadie3

  • 1Centre for Endoscopic and Minimally Invasive Neurosurgery, Zurich, Switzerland.

World Neurosurgery
|December 16, 2014
PubMed
Summary

Minimally invasive supraorbital keyhole surgery with endoscope-assisted microsurgery safely treats intracranial aneurysms. This technique offers excellent outcomes for incidental aneurysms and good results for ruptured ones, with no approach-related complications.

Keywords:
Intracranial aneurysmsKeyhole neurosurgeryMinimally invasive neurosurgerySupraorbital craniotomyTranscranial endoscope-assisted microneurosurgery

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Surgery
  • Endoscopic Surgery

Background:

  • Intracranial aneurysms require effective treatment strategies.
  • Minimally invasive approaches aim to reduce surgical morbidity.
  • The supraorbital keyhole craniotomy offers a less invasive surgical corridor.

Observation:

  • A supraorbital keyhole approach was utilized in 793 cases for 989 intracranial aneurysms.
  • Endoscopes were routinely employed to enhance visualization during the limited subfrontal craniotomy.
  • Surgical outcomes were evaluated using the modified Rankin scale.

Findings:

  • Endoscope-assisted microneurosurgery via the supraorbital approach demonstrated safety and efficacy.
  • Excellent outcomes (modified Rankin scale ≤2) were achieved in 96.52% of incidental aneurysms.
  • Good outcomes (modified Rankin scale ≤2) were observed in 72.2% of ruptured aneurysms, with no approach-related complications.

Implications:

  • The supraorbital keyhole approach is a safe and effective minimally invasive option for intracranial aneurysms, including those presenting with subarachnoid hemorrhage.
  • Enhanced endoscopic visualization improves clip placement assessment and control of critical structures.
  • This technique holds promise for improving patient outcomes in aneurysm treatment.