gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Article

Send article

One-stage clipping of bilateral middle cerebral aneurysms via distal trans-sylvian key-hole approach

Meeting Abstract

Search Medline for

  • R. Hatanaka - Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
  • K. Maruyama - Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
  • H. Kurita - Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
  • R. Yamaguchi - Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
  • Y. Shiokawa - Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 050

doi: 10.3205/12dgnc437, urn:nbn:de:0183-12dgnc4371

Published: June 4, 2012

© 2012 Hatanaka 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

Text

Objective: Multiple cerebral aneurysms are commonly amenable to endovascular embolization. Considering therapeutic curativity, we applied one-stage clipping by using minimally invasive approach, even for bilateral aneurysms. Hereby the authors report its surgical technique and their initial treatment result.

Methods: Six patients underwent one-stage clipping of unruptured aneurysms in the bilateral middle cerebral arteries (mean size 5.6 mm, range 2 to 13 mm) via distal trans-sylvian key-hole approach in our institute. Mean patient age was 58 years (range 42 to 73 years). Technical tips are as follows; a patient head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; 5 cm curvilinear skin incision is made inside the hairline and 2-burr-hole small pterional craniotomy is made bilaterally; whole operating table is rotated 15 degree to one side to facilitate microsurgical trans-sylvian approach and aneurysmal clipping; operating table is rotated to the other side for the contralateral procedure; particular care is taken to avoid bilateral brain injury.

Results: This approach provided minimal but sufficient working space required for trans-sylvian approach. Aneurysmal neck clipping was safely performed with no complications and satisfactory cosmetic result in all patients. Mean operation time was 5 hours 17 minutes excluding one patient, who underwent bilateral manipulation separately. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimal consequence of brain retraction.

Conclusions: One-stage clipping via distal trans-sylvian key-hole approach is a safe and effective therapeutic option for small aneurysms in the bilateral hemispheres.