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Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage: a prospective study at a single institute

  • Experimental Research
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Abstract

Objective

A prospective study was underway to evaluate the outcome of eyebrow keyhole approach for ruptured anterior circulation aneurysms on early stage.

Methods

In the past 4 years, 88 patients with ruptured anterior circulation aneurysms, were operated on early stage by an experienced neurosurgical team through eyebrow craniotomy. The clinical data were analyzed.

Results

Patients with Hunt and Hess Grade I–II (85.2%) or III (14.8%) were selected for eyebrow approach on early stage. All aneurysms were small (20.5%) or middle (79.5%) in size. All but seven (92.0%) aneurysms were clipped successfully. The opening of frontal sinus occurred in 11(12.5%) cases through eyebrow approach. Of all, 78 (88.6%) patients achieved favorable outcomes.

Conclusions

Eyebrow keyhole approach for ruptured anterior circulation aneurysms on early stage might be in particular selected according to the Hunt and Hess Scale, the projection of aneurysm, the length of M1 segment, the location of cerebral hematoma, the size and complexity of aneurysm, as well as the preference and experience of the neurosurgical team.

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Acknowledgement

This work was funded by the Health Bureau of Fujian (No. A0000063) and the Health Bureau of Xiamen, China.

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Authors and Affiliations

  1. Department of Neurosurgery, Zhongshan Hospital, Xiamen University, Xiamen, 361004, People’s Republic of China

    Lukui Chen, Xinhua Tian, Junqing Zhang, Yanlin Huang & E. Chen

  2. Department of Neurosurgery, Second Affiliated Hospital, Soochow University, Suzhou, People’s Republic of China

    Qing Lan

Authors
  1. Lukui Chen
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  2. Xinhua Tian
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  3. Junqing Zhang
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  4. Yanlin Huang
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  5. E. Chen
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  6. Qing Lan
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Corresponding author

Correspondence to Lukui Chen.

Additional information

Comment

The authors present a medium sized series of ruptured anterior circulation aneurysms surgically treated with a small eyebrow craniotomy. The results were generally excellent, with the exception of the infection rate of some 10% that appears a bit high.

The point of the manuscript is to demonstrate that the small eye brow craniotomies can work with acute SAH. The authors did not operate on all ruptured anterior circulation aneurysms by this approach, but on an increasing proportion during the study period. Complex aneurysms and brain swelling on CT were considered contraindications for the small craniotomy. Systematic lumbar or ventricular CSF drainage was not used in this series and sufficient brain relaxation depended on cisternal access during initial dissection. Use of spinal or ventricular CSF drainage during surgery is in my opinion important for keyhole aneurysm surgery in the acute stage after SAH, particularly in cases of severe haemorrhage.

The authors comment also on the problems associated with opening the frontal sinus during supraorbital craniotomies. Although there is no discussion on the necessity of utmost care with the closure of the dura and the sinus, most of us probably would not agree with using foreign material in the frontal sinus.

H.-J. Steiger

Duesseldorf, Germany

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Chen, L., Tian, X., Zhang, J. et al. Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage: a prospective study at a single institute. Acta Neurochir 151, 781–784 (2009). https://doi.org/10.1007/s00701-009-0205-9

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  • DOI: https://doi.org/10.1007/s00701-009-0205-9

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