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Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex—a cadaveric study

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Introduction

In selected cases, microsurgical clipping remains a valuable treatment alternative to endovascular occlusion of anterior communicating artery (AComA) aneurysms. Their clipping is challenging and carries a risk of postsurgical cognitive impairment. We evaluate the microsurgical anatomy of a new, minimally invasive combined interhemispheric-subfrontal approach to the AComA complex via a medial supraorbital craniotomy.

Methods

In this descriptive anatomic study, four alcohol-embedded, silicon-injected human cadaver heads were used. In each of the two cadavers, the AComA complex was approached from either the right or left side. An operating microscope and standard microsurgical instruments were used.

Results

After a medial eyebrow incision, a medial supraorbital minicraniotomy was performed. The frontal sinus was opened and cranialized. Following the dural opening, a subfrontal arachnoid dissection was performed to identify the optico-carotid complex. By following the A1 segment, a low-lying AComA complex could be visualized. Shifting the corridor towards the midline enabled an interhemispheric dissection. This dissection resulted in a wide superior-inferior corridor. Higher-lying AComA complexes could also be visualized. The achieved exposure of the AComA complex would allow safe dissection and clipping of low- and high-lying AComA aneurysms, with minimal retraction and preservation of the surrounding anatomical structures, in particular the perforators.

Conclusions

We demonstrate the anatomy of a novel approach for surgical clipping of AComA aneurysms. Our study suggests that this approach provides good exposure without concomitant structural and vascular injury and thus might reduce the risk of procedure-related morbidity.

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Acknowledgments

The study was partially supported by a research grant from the Research Fund of the Kantonsspital Aarau. The authors have no conflicts of interest to declare. This study has been approved by the local ethics committee (approval no. KEK-ZH 2015–0306)

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Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland

    Alexander Spiessberger, E. Nevzati, J. Fandino & C. Muroi

  2. Department of Neurosurgery, Luzerner Kantonsspital, Luzern, Switzerland

    F. Baumann, E. Nevzati & K. F. Kothbauer

Authors
  1. Alexander Spiessberger
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  2. F. Baumann
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  3. E. Nevzati
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  4. K. F. Kothbauer
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  5. J. Fandino
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  6. C. Muroi
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Corresponding author

Correspondence to Alexander Spiessberger.

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Funding

The Research Fund of the Kantonsspital Aarau provided financial support in the form of 5300 Swiss Francs (number: 1410.000.059). The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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This article does not contain any studies with human participants performed by any of the authors.

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Spiessberger, A., Baumann, F., Nevzati, E. et al. Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex—a cadaveric study. Acta Neurochir 159, 1079–1085 (2017). https://doi.org/10.1007/s00701-017-3159-3

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  • DOI: https://doi.org/10.1007/s00701-017-3159-3

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