Artikel
Endoscopic assisted clipping of ophtalmic aneurysms via supraorbital keyhole approach – a monocentric case study
Endoskopisch assistiertes Clipping von Ophtalmica-Aneurysmen via supraorbitale Kraniotomie – eine monozentrische Fallstudie
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Veröffentlicht: | 8. Mai 2019 |
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Objective: Operative treatment of ophthalmic aneurysms usually requires precise surgical manipulation in a very limited operative field. Therefore the extended pterional approach is still considered to be the gold-standard for such procedures. However, minimally invasive concepts and strategies open up new perspectives to approach such lesions. Here the endoscopic assisted supraorbital keyhole approach might become a valuable alternative to the current handling.
Methods: Clipping procedures due to unruptured intracranial aneurysms between January 2013 till December 2017 were extracted out of the department’s internal database. Out of 454 results, ten patients with at least one DSA confirmed ophthalmic aneurysm were included in the final analysis. Medical assessment data and documentation, radiologic imaging, treatment modalities and follow-up documentation were retrospectively collected and analyzed. Intraoperative video documentation was stored and reviewed by an objective neurosurgeon. Further descriptive statistics were carried out for subgroups stratified according to the surgical approach.
Results: Six patients (60%) were operated via a supraorbital keyhole approach, while in four patients (40%) a pterional craniotomy was performed. Median aneurysm size was 24.63mm3 (p25: 13.95mm3; p75: 34.99mm3) in the supraorbital group and 111.78mm3 (p25: 38.63mm3; p75: 347.1mm3) in the pterional group. Average craniotomy size ranged from 27.7x21.2mm in the supraorbital cohort to 52.2x36.0mm in the pterional cohort. Neuroendoscopic technique was used in all supraorbital cases and in none of the pterional cases. There were neither intraoperative bleeding complications, nor perioperative ischemic deficits. Operative success rate, confirmed by digital subtraction angiography within 3–12 months, was 100% in both groups. There were no postoperative complications and no neurological deterioration.
Conclusion: Supraorbital keyhole approach is a safe and less invasive alternative to the pterional approach in selected cases of ophthalmic aneurysms. If possible, the combination with neuroendoscopic techniques is highly recommended. In this way, a high operative success rate can be maintained by gaining perfect illustration of the anatomical structures as well as angled depiction within a limited operative field.