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논문 기본 정보

자료유형
학술저널
저자정보
Choi, Yeon-Ju (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) Son, Wonsoo (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) Park, Ki-Su (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University) Park, Jaechan (Department of Neurosurgery, Research Center for Neurosurgical Robotic Systems, Kyungpook National University)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제59권 제6호
발행연도
2016.1
수록면
564 - 569 (6page)

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Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.
#Intracranial aneurysm #Middle cerebral artery #Pterional approach #Superciliary approach

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참고문헌 (17)

참고문헌 신청
Chalouhi N / 2013 / Surgical treatment of ruptured anterior circulation aneurysms : comparison of pterional and supraorbital keyhole approaches / Neurosurgery 72:437~441 google schola Cheng CM / 2013 / Quantitative verification of the keyhole concept : a comparison of area of exposure in the parasellar region via supraorbital keyhole, frontotemporal pterional, and supraorbital approaches / J Neurosurg 118:264~269 google schola Czirják S / 2002 / Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions / Surg Neurol 57:314~323 google schola Czirják S / 2001 / Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision / Neurosurgery 48:145~149 google schola Davies JM / 2014 / Advances in open microsurgery for cerebral aneurysms / Neurosurgery 74(Suppl 1):S7~S16 google schola

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