251. Monolateral Pterional Keyhole Approaches to Bilateral Cerebral Aneurysms: Anatomy and Clinical Application.
- Author
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Yu LH, Shang-Guan HC, Chen GR, Zheng SF, Lin YX, Lin ZY, Yao PS, and Kang DZ
- Subjects
- Adult, Aged, Carotid Artery, Internal anatomy & histology, Carotid Artery, Internal diagnostic imaging, Cerebral Angiography, Cerebral Arteries anatomy & histology, Cerebral Arteries diagnostic imaging, Computed Tomography Angiography, Humans, Imaging, Three-Dimensional, Intracranial Aneurysm diagnostic imaging, Middle Aged, Postoperative Complications, Retrospective Studies, Treatment Outcome, Carotid Artery, Internal pathology, Carotid Artery, Internal surgery, Cerebral Arteries pathology, Cerebral Arteries surgery, Intracranial Aneurysm pathology, Intracranial Aneurysm surgery
- Abstract
Objective: To study the anatomy and clinical application of monolateral pterional keyhole approaches for treating bilateral cerebral aneurysms., Methods: Twelve formalin-fixed cadaveric heads underwent right pterional keyhole approaches for management of simulative contralateral aneurysms. The length of the contralateral middle cerebral artery (MCA), distal internal carotid artery (DICA), anterior cerebral artery, and ophthalmic segment of the internal carotid artery (OICA) was recorded. The operability of contralateral aneurysms was assessed using a modified numeric grading system. A total of 16 patients (12 patients with ruptured aneurysms) with bilateral cerebral aneurysms undergoing contralateral pterional keyhole approaches were included., Results: The contralateral A1 segment of the anterior cerebral artery, proximal A2 segment, M1 segment of the MCA, DICA, and OICA was exposed via pterional keyhole approaches. An additional 2 mm of the OICA was exposed after incision of the falciform dural fold was completed. Contralateral aneurysms of the M1 segment (posterior), M2 segment, MCA bifurcation (inferior), A2 segment (lateral), DICA (posterior and lateral), and OICA (superior, inferior, and lateral) could not be fully exposed to perform simulated surgical clipping (operability rate <75%). A total of 36 aneurysms underwent adequate surgical clipping via unilateral pterional keyhole approaches, whereas 1 aneurysm of the A3 segment did not., Conclusions: Contralateral aneurysms of the M1 segment (anterior, superior, and inferior), MCA bifurcation (superior and lateral), A1 segment, A2 segment (anterior, posterior, and medial), internal carotid artery bifurcation, DICA (anterior and medial), and OICA (medial) were fully exposed from different angles and surgical maneuvers were performed via pterional keyhole approaches, including in patients presenting with subarachnoid hemorrhage., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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