Journal of Korean Neurosurgical Society

  • 제59권6호
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  • Pages.564-569
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  • 2016
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Intradural Procedural Time to Assess Technical Difficulty of Superciliary Keyhole and Pterional Approaches for Unruptured Middle Cerebral Artery Aneurysms

  • Choi, Yeon-Ju (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) ;
  • Son, Wonsoo (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) ;
  • Park, Ki-Su (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University)
  • 투고 : 2016.02.25
  • 심사 : 2016.06.21
  • 발행 : 2016.11.01
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초록

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

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참고문헌

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  2. Bilateral supraorbital keyhole approach in surgery of multiple cerebral aneurysms: a case report and literature review vol.83, pp.3, 2016, https://doi.org/10.17116/neiro20198303193
  3. Pterional versus superciliary keyhole approach: direct comparison of approach-related complaints and satisfaction in the same patient vol.130, pp.1, 2016, https://doi.org/10.3171/2017.8.jns171167
  4. Pterional versus superciliary keyhole approach: direct comparison of approach-related complaints and satisfaction in the same patient vol.130, pp.1, 2016, https://doi.org/10.3171/2017.8.jns171167
  5. Letter to the Editor. Minimally invasive techniques: the new frontier in neurosurgery vol.130, pp.1, 2016, https://doi.org/10.3171/2018.6.jns181491
  6. Letter to the Editor. Minimally invasive techniques: the new frontier in neurosurgery vol.130, pp.1, 2016, https://doi.org/10.3171/2018.6.jns181491
  7. Letter to the Editor. Minimally invasive techniques: the new frontier in neurosurgery vol.130, pp.1, 2016, https://doi.org/10.3171/2018.6.jns181491
  8. Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms : A Systematic Review and Meta-analysis vol.76, pp.3, 2019, https://doi.org/10.1001/jamaneurol.2018.4165
  9. International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery vol.44, pp.1, 2021, https://doi.org/10.1007/s10143-019-01188-z