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Background: In this video abstract, we present a one burr-hole craniotomy for the standard lateral supraorbital approach (LSO) developed by Helsinki Neurosurgery. This is a more aesthetic variant of the classic pterional approach. Presently, the LSO approach is most commonly used at our institution. With the LSO technique, the temporal muscle is just minimally opened close to its superior insertion. Posterior and temporal extension of the craniotomy, furthermore, allows adequate access to the anterior skull base, the sellar and suprasellar regions, the middle cranial fossa, the anterior portion of the Sylvian fissure, and the distal Sylvian fissure. Even though the specific location and size of the lesion may vary, this approach accesses all mentioned structures with a very minimal variation. Case Description: The patient with an unruptured anterior communicating artery aneurysm is placed in supine position with the head elevated 30 cm from the level of the heart. The head position is determined by the specific location of the lesion. A curved frontotemporal skin incision is made behind the hairline which stops 2-3 cm above the zygoma. Anterior retraction and hemostatic Raney clips placed at the posterior border of the skin flap maintain a clean space for the craniotomy. A burr-hole is made at the level of the temporal line in the frontal bone. After the dura is detached with blunt dissection, a craniotomy is performed to reach the anterior skull base. A few drill holes are made for tack-up sutures and the dura is opened using conventional techniques. The anterior skull base, sellar/suprasellar regions, and select lesions located in the upper basilar region may be accessed through this subfrontal approach. Middle cerebral artery aneurysms and lesions located along the sylvian fissure or in the middle fossas may also be approached with this exposure, but would require further opening of the proximal sylvian fissure. Conclusion: There we described the LSO one burr-hole craniotomy technique that may represent a more efficient procedure for performing LSO. [ABSTRACT FROM AUTHOR]

Objective: To explore the therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults. Methods: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was performed on 21 adults with ischemic moyamoya disease since January 2013 in the second hospital of Shandong university.All of the patients were followed up for 3 months to 3 years.Digital subtraction angiogram (DSA) reexamination was performed and the cerebral MR perfusion imaging (PWI) was used to observe the perfusion of cerebral ischemic area before and after operation quantificationally, and the KPS scores before and after the surgery were analysed by the statistics.The clinical symptoms of the 21 patients gradually improved after the operation, there was statistical significance by paired t test of the KPS scores ( P <0.001). Results: 19 patients were reexamined by DSA and PWI.The DSA results revealed there was apparent neovascularization in 65 burr-holes of total 72 holes , mainly came from the middle meningeal artery and superficial artery, and there was neovascularization in 33 burr-holes of total 35 holes whose arachnoid was completed, there was no statistical significance by χ(2) test ( P >0.05). The revascularization of the ischemic cerebral tissue was obtained through the PWI.The postoperative complications included 1 case of subdural hematoma, 3 cases of postoperative temporary neurological deficits. Conclusion: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was effective, the MR perfusion imaging could assessment the effect exactly, there was no significant difference of neovascularization whether or not opening the arachnoid.

Objective: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point., Methods: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed., Results: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC., Conclusion: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.

Introduction: Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis., Methods: All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals., Results: A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses., Conclusion: There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available., (Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.)