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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Minimal invasive supra-orbital incision for cerebral aneurysm clipping: results over a 5-year period

Meeting Abstract

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  • J. Wuyts - Department of Neurosurgery, Ziekenhuis Oost-Limburg
  • C. De Deyne - Department of Anesthesia, Ziekenhuis Oost-Limburg
  • D. Peuskens - Department of Neurosurgery, Ziekenhuis Oost-Limburg
  • J. Deckers - Department of Neurosurgery, Ziekenhuis Oost-Limburg
  • K. Engelborghs - Department of Neurosurgery, Ziekenhuis Oost-Limburg
  • F. Weyns - Department of Neurosurgery, Ziekenhuis Oost-Limburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.02-02

doi: 10.3205/09dgnc112, urn:nbn:de:0183-09dgnc1127

Published: May 20, 2009

© 2009 Wuyts et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Supra-orbital incision offers a minimal invasive surgical approach for cerebral aneurysm surgery and clipping. Since 2004, we introduced this technique for all pts presenting for elective cerebral aneurysm surgery and treated by the same neurosurgeon. In this paper, we want to present a retrospective analysis of this 5-years experience.

Methods: Over this 5-year period, 98 pts scheduled for elective cerebral aneurysm surgery underwent craniotomy by supra-orbital incision performed by the same neurosurgeon. In 65 pts, the aneurysm was located on the medial cerebral artery; in 11 pts it was located on the internal carotid artery, whereas in the other 22 pts the anterior communicating artery was involved. 9 pts presented with multiple aneurysms, in 8 pts multiple aneurysms were clipped in one surgical procedure.

Results: In 95 of 98 pts, the cerebral aneurysm was successfully clipped and perioperative course was uneventful. In 2 pts, it seemed impossible to clip the aneurysm due to anatomical characteristics. One pt was treated by endovascular approach; in the other pt a second surgical approach (by supra-orbital incision) did result in successful clipping of the aneurysm thanks to the use of a differently positioned temporary clip. In 1 pt, intra-operative bleeding occurred during surgical manipulation of the aneurysm, with ensuing brain bulging and a large craniotomy had to be performed.

We noted a significantly shorter mean surgical procedure time compared to standard procedure times for cerebral aneurysm clipping before 2004 (m195min vs. m329min). Probably due to this shortened mean surgical time, we observed a significantly shorter time to awakening (m135min vs. m285min after ICU admission). 92 of 98 pts were discharged from ICU within 36hrs of admission, and 32 pts were even discharged within the first 12hrs of ICU admission. Mean hospital stay was 6 days, with 5 pts leaving the hospital within 3 days after surgical intervention.

Conclusions: In conclusion, our data confirm all advantages of minimal invasive neurosurgical approach for cerebral aneurysm clipping. The less invasive approach guarantees as well optimal surgical conditions as significantly shortened procedure time and ICU - hospital stay.