The modified pterional keyhole craniotomy for open cerebrovascular surgery: a new workhorse?

The frontotemporal craniotomy is the most commonly used approach for vascular neurosurgery. However, this approach requires significant mobilization of overlying soft tissues, resulting in muscle atrophy and temporomandibular joint pain. We describe a modified pterional keyhole approach and its use in our initial clinical experience.
Eleven consecutive minimally invasive pterional keyhole approaches were used for 14 aneurysms. Patient demographics, aneurysm characteristics, and morbidities were prospectively collected.
Mean aneurysm size was 6.5 mm, and all were in the anterior circulation. All aneurysms were successfully clipped, with no occurrence of intraoperative rupture or perforator occlusion. There were no incidences of frontalis nerve injury. No technical difficulties or limitation to aneurysm access were experienced.
In carefully selected patients, a minimally invasive keyhole approach may be a safe and effective alternative to traditional pterional craniotomy for certain anterior circulation aneurysms.
AuthorsJ Mocco, Ricardo J Komotar, Daniel M S Raper, Christopher P Kellner, E Sander Connolly, Robert A Solomon
JournalJournal of neurological surgery. Part A, Central European neurosurgery (J Neurol Surg A Cent Eur Neurosurg) Vol. 74 Issue 6 Pg. 400-4 (Nov 2013) ISSN: 2193-6323 [Electronic] Germany
PMID23427039 (Publication Type: Journal Article)
CopyrightGeorg Thieme Verlag KG Stuttgart · New York.
  • Aged
  • Cerebrovascular Circulation
  • Cerebrovascular Disorders (surgery)
  • Cranial Nerve Injuries (epidemiology, etiology)
  • Craniotomy (methods)
  • Female
  • Humans
  • Intracranial Aneurysm (surgery)
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures (methods)
  • Neurosurgical Procedures (methods)
  • Osteotomy
  • Patient Positioning
  • Postoperative Complications (epidemiology)
  • Prospective Studies
  • Surgical Instruments
  • Treatment Outcome

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