Comparative study of minimally invasive and traditional approaches for the microsurgical treatment of circle of Willis unruptured intracranial aneurysms

Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.Material and Methods. We conducted a comparative analysis of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; in the second group, patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics

SUPRAORBITAL KEYHOLE CRANIOTOMY IN SURGERY OF INTRA- AND EXTRA-AXIAL BRAIN TUMORS

Background. Priority objectives of surgical neurooncology (diagnosis verification, tumor cytoreduction, and preservation of patient’s functional status) can be achieved both through traditional neurosurgical approaches and through the use of keyhole surgery. Keyhole surgery allows to minimize unnecessary, extended resection of the skull base and long-term static brain tissue retraction.Objective. The authors present preliminary results of the use of supraorbital keyhole craniotomy in intra- and extra-axial brain tumors. Materials and methods. In 2014–2016, 45 patients were operated through supraorbital craniotomy to treat intra- and extra-axial tumors. The majority of patients (n = 28) was diagnosed with anterior cranial fossa meningiomas. Gliomas of the frontal lobe were diagnosed in 12 patients. The average tumor size ranged from 3 to 3.5 cm.Results. Mortality, disability, or serious permanent access-related complications were not observed in our group. In all cases, the transition to the classical craniotomy was not required. Periorbital edema and transient hypoesthesia were observed in all patients. Permanent frontal hypoesthesia was observed in 3 patients (4 %) for a time period up to six months. According to postoperative MRI performed in all patients at the time of discharge, in the group of intra-axial brain tumor gross-total removal was observed in 8 patients (47 %), in 9 patients (53 %) the tumor was near-totally removed (more than 90 % of the tumor), in the group of meningiomas all 28 patients had gross-total removal. Conclusion. Supraorbital craniotomy can be an effective and safe alternative to classic approaches to treatment of extra-axial tumors of the anterior cranial fossa and intra-axial tumors of the frontal lobe. The approach requires a very careful selection of patients, individualization of surgery, and further critical evaluation