Lateral Supraorbital Approach for the Surgical Clipping of Ruptured Tiny Anterior Circulation Aneurysms.

Abstract

To evaluate the efficacy and usefulness of clipping procedure by lateral supraorbital approach for tiny anterior circulation aneurysms. An observational study. Department of Neurosurgery, The Second Hospital of Anhui Medical University, Hefei, Anhui Province, China, from January 2013 to March 2018. Thirty-eight patients who had suffered aneurysm rupture, resulting in subarachnoid hemorrhage, were selected. Fourty-four very small aneurysms with a maximum diameter of ≤3 mm that presented different configurations, were identified using digital subtraction angiography (DSA). Clinical data of patients, including clinical information, microsurgery procedure, procedural complications, clinical outcomes, and follow-up were analysed. All ruptured aneurysms involved the anterior circulation, located in middle cerebral artery (19/38), anterior communicating artery (10/38), posterior communicating artery (6/38), anterior choroidal artery (2/38), and ophthalmic artery (1/38). Complete occlusions were achieved in all of the lesions by surgical clipping via the lateral supraorbital approach. There were no intra-procedural ruptures or procedure-related vasospasm, epilepsy, hydrocephalus. Glasgow outcome scale (GOS) scores showed that 34 patient (86.84%) had good outcomes (GOS 4-5) at the time of discharge. There was no residual neck or recurrence following computed tomography angiography (CTA) and DSA at follow-up in 20 cases. Surgical clipping via lateral supraorbital approach presented a low rate of adverse events related to the procedure, and was safe and effective in ruptured tiny aneurysms. Key Words: Tiny aneurysm; Surgical clipping; Clinical outcome; Lateral supraorbital approach.