Transblepharo-Preseptal Modified Orbitozygomatic Approach for the Treatment of Ruptured Proximal Anterior Circulation Aneurysms

Robert C Rennert; Ben A Strickland; Kristine Ravina; Joshua Bakhsheshian; Joseph Carey; Jonathan J Russin

doi:10.1016/j.wneu.2018.06.188

Transblepharo-Preseptal Modified Orbitozygomatic Approach for the Treatment of Ruptured Proximal Anterior Circulation Aneurysms

World Neurosurg. 2018 Oct:118:e335-e345. doi: 10.1016/j.wneu.2018.06.188. Epub 2018 Jul 2.

Authors

Robert C Rennert¹, Ben A Strickland², Kristine Ravina³, Joshua Bakhsheshian², Joseph Carey⁴, Jonathan J Russin⁵

Affiliations

¹ Department of Neurological Surgery, University of California San Diego, San Diego, USA.
² Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
³ Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
⁴ Department of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁵ Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA. Electronic address: jonathan.russin@med.usc.edu.

PMID: 30257293
DOI: 10.1016/j.wneu.2018.06.188

Abstract

Background: Minimally invasive skull base approaches, including the cosmetically optimal transblepharo-preseptal modified orbitozygomatic (TBMOZ) technique, have been described to treat proximal anterior circulation aneurysms. The use of minimally invasive techniques for previously ruptured aneurysms is rare because of perceived technical challenges in controlling intraoperative ruptures. Herein, we determine the utility of the minimally invasive TBMOZ approach for the treatment of ruptured proximal anterior circulation aneurysms.

Methods: A retrospective analysis of an institutional review board-approved, prospective database was performed to identify patients with ruptured anterior circulation aneurysms treated with a TBMOZ approach. Patient demographics, aneurysm characteristics, temporary clip time, intra-operative ruptures, and neurologic outcomes were recorded.

Results: Fifteen patients (9 females, 6 males; average age, 53.6 ± 12.2 years) underwent a TBMOZ craniotomy following subarachnoid hemorrhage for clipping of 17 aneurysms (12 anterior communicating, 3 posterior communicating, and 2 carotid terminus). Four of 15 patients (26.6%) experienced intraoperative rupture, which was easily controlled in all patients and did not affect clinical outcomes. All patients had complete aneurysm ablation confirmed on postoperative cerebrovascular imaging. Good neurologic outcomes (Glasgow Outcome Score [GOS] of 5) were achieved in 73.3% (n = 11) of patients at time of hospital discharge; the remaining patients had a GOS of 3-4. No patients experienced frontalis muscle weakness or facial nerve injuries, and all patients had acceptable cosmetic outcomes. One patient (6.6%) experienced a surgery-related complication: postoperative versus vasospasm-induced perforator infarcts.

Conclusions: The TBMOZ approach provides a minimally invasive option for the safe treatment of previously ruptured proximal anterior circulation aneurysms.

Keywords: Eyebrow approach; Minimally invasive craniotomy; Ruptured aneurysm; Transblepharo-preseptal modified orbitozygomatic approach.

Publication types

Case Reports

MeSH terms

Adult
Aged
Aneurysm, Ruptured / diagnostic imaging
Aneurysm, Ruptured / surgery*
Craniotomy / methods*
Eyelids / diagnostic imaging
Eyelids / surgery*
Female
Humans
Intracranial Aneurysm / diagnostic imaging
Intracranial Aneurysm / surgery*
Male
Microsurgery / methods*
Middle Aged
Neurosurgical Procedures / methods*
Orbit / diagnostic imaging
Orbit / surgery
Retrospective Studies
Treatment Outcome