The minipterional craniotomy for anterior circulation aneurysms

Initial experience with 72 patients

Justin Caplan, Kyriakos Papadimitriou, Wuyang Yang, Geoffrey P. Colby, Alexander Coon, Alessandro Olivi, Rafael J Tamargo, Judy Huang

Research output: Contribution to journalArticle

Abstract

Background: The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. Objective: To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. Methods: From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. Results: The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average followup was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. Conclusion: The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

Original languageEnglish (US)
Pages (from-to)200-206
Number of pages7
JournalNeurosurgery
Volume10
DOIs
StatePublished - 2014

Fingerprint

Craniotomy
Aneurysm
Middle Cerebral Artery
Internal Carotid Artery
Muscles
Dissection
Subdural Hematoma
Myocutaneous Flap
Middle Cerebral Artery Infarction
Wound Infection
Reoperation
Surgical Instruments
Cosmetics
Hospitalization

Keywords

  • Cerebral aneurysms
  • Craniotomy
  • Minimally invasive surgery
  • Surgical technique

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The minipterional craniotomy for anterior circulation aneurysms : Initial experience with 72 patients. / Caplan, Justin; Papadimitriou, Kyriakos; Yang, Wuyang; Colby, Geoffrey P.; Coon, Alexander; Olivi, Alessandro; Tamargo, Rafael J; Huang, Judy.

In: Neurosurgery, Vol. 10, 2014, p. 200-206.

Research output: Contribution to journalArticle

Caplan, Justin ; Papadimitriou, Kyriakos ; Yang, Wuyang ; Colby, Geoffrey P. ; Coon, Alexander ; Olivi, Alessandro ; Tamargo, Rafael J ; Huang, Judy. / The minipterional craniotomy for anterior circulation aneurysms : Initial experience with 72 patients. In: Neurosurgery. 2014 ; Vol. 10. pp. 200-206.
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abstract = "Background: The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. Objective: To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. Methods: From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. Results: The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average followup was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96{\%} of patients. Conclusion: The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.",
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AU - Papadimitriou, Kyriakos

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AU - Huang, Judy

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AB - Background: The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. Objective: To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. Methods: From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. Results: The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average followup was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. Conclusion: The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

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KW - Minimally invasive surgery

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