Article
The keyhole concept in aneurysm surgery: Results from the past 22 years
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Authors
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G. Fischer
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz
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J. Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
| Published: | April 28, 2011 |
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Outline
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Objective: Improvements in preoperative imaging and intraoperative visualization have led to a refinement in surgical techniques. As a contribution to the ongoing debate on the impact of keyhole approaches in aneurysm surgery, the experience of 22 years with consequent application of keyhole technique is reported as a retrospective single-center study.
Methods: Over a 22-year period, 1082 consecutive patients with 1393 aneurysms were surgically treated in 1146 operations; 693 in the acute stage after SAH and 453 with unruptured aneurysms. Outcome was assessed using the modified Rankin scale as well as approach-related complications.
Results: The majority of cases were treated by four different keyhole approaches: the supraorbital approach was used to treat 1057 aneurysms, the subtemporal for 50 aneurysms, the interhemispheric for 51 aneurysms, the retromastoidal for 59 aneurysms. The classic pterional approach was applied to treat 176 aneurysms. The complication rates of the keyhole approaches were less than in the pterional group, although the difference did not reach a statistical significance.
Conclusions: The overall outcome, the rate of re-treatment and approach-related complications using a keyhole approach for the management of ruptured and unruptured aneurysms are comparable with recently published conventional surgical aneurysm series. In addition to the common benefits of limited exposure approaches, this series demonstrates the appropriate safety and applicability of the keyhole technique in aneurysm surgery as well.
