Imaging and surgical characteristics of lateral orbital keyhole approach in treatment of ruptured internal carotid artery bifurcation aneurysms originated from different aneurysmal necks
10.3760/cma.j.cn441206-20240415-00101
- VernacularTitle:眶外侧锁孔入路治疗不同瘤颈起源的破裂颈内动脉分叉部动脉瘤的影像及手术特点
- Author:
Yuchen LUO
1
;
Hongwei ZHANG
;
Xiguang LIU
Author Information
1. 南京医科大学连云港临床医学院神经外科，连云港 222002
- Publication Type:Journal Article
- Keywords:
Intracranial aneurysm;
Lateral orbital keyhole approach;
Internal carotid artery bifurcation;
Neuro-microsurgieal operation;
Medical imagine
- From:
Chinese Journal of Microsurgery
2024;47(6):641-646
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the characteristics of medical imaging and surgical procedure of the lateral orbital keyhole (LOK) approach in treatment of ruptured internal carotid artery bifurcation aneurysms (ICABifAs) originated from different aneurysmal necks, therefore to provide a clinical guidance for the treatment.Methods:A retrospective analysis was carried out based on the clinical data and pre-, intra- and post-operative images of 23 patients with ICABifAs that were diagnosed and treated in the Department of Neurosurgery, Lianyungang Clinical Medical College of Nanjing Medical University from January 2017 to June 2023. All patients were treated with craniotomy and clipping through the LOK approach. According to different origins, the aneurysmal necks were divided into type A1 (A1), type M1 (M1) and type ICA (ICA). Ratios of angle and diameter between A1 (M1) and ICA were measured on 3D CTA images, and the correlation analysis was performed. Postoperative follow-ups were conducted at 2 weeks and 1, 3, and 6 months after surgery, together with reviews of head CT, CTA or DSA and physical examinations. The surgical outcomes were evaluated by Glasgow Outcome Scale (GOS). Microsoft Excel and SPSS 27.0 statistical software were used to analyse the data. The diameter of the end of A1, M1, ICA and the angle between ICA, the diameter of tumor neck, and the paired sample t- test were used to analyse the size differences, and correlation analysis was used to explore the relationships with them. P<0.05 was considered a statistically significant different. Results:In this study, 12 patients (52.2%) were found with A1 aneurysmal neck, 1 (4.3%) with M1 and 10 (43.5%) with ICA. The diameter of A1 and the angle between A1 and ICA were found both smaller than those of M1. The angle between A1 and ICA was positively correlated with the angle between M1 and ICA. The angle between A1 and ICA was negatively correlated with the diameter of A1 aneurysms. All of 23 patients of ICABifAs were successfully clipped. One patient had a ptosis on the operated side and returned to normal (GOS=5) at 3 months after surgery; Postoperative hemiplegia occurred on the opposite site (Grade Ⅰ for upper limb muscle strength and Grade Ⅱ for lower limb muscle strength) in 1 patient who had Hunt-Hess grade IV before surgery, however, GOS 3 was found at 6 months after surgery (of contralateral limbs, Grade Ⅱ for upper limb strength and Grade Ⅲ for lower limb muscle strength); One patient had contralateral limb movement impairment after surgery (Grade Ⅲ for upper limb muscle strength and Grade IV for lower limb muscle strength), with GOS 5 at 6 months after surgery; One patient with preoperative Fisher classification IV developed secondary hydrocephalus at 2 months after surgery, with GOS 4 at 6 months after surgery. The other 20 patients were all in stable condition after surgery.Conclusion:Among the ICABifAs, A1 aneurysmal neck is the most common type, while ICA is slightly less and M1 is the least type. The angle between A1 and ICA is positively related to the angle between M1 and ICA. The angle between A1 and ICA is negatively correlated with the diameter of A1 aneurysm. Treatment of ruptured ICABifAs through a LOK approach is a feasible and effective minimally invasive procedure.
