Microsurgical Treatment of Posterior Cerebral Circulation Aneurysms Via Keyhole Approaches

ObjectiveTo explore the techniques of microsurgical treatment for posterior cerebral circulation aneurysms via keyhole approaches and assess its feasibility.MethodsA total of 27 patients with 28 posterior cerebral circulation aneurysms were treated surgically by keyhole approaches; 24 patients presented with subarachnoid hemorrhage and 3 with headache. Of these 27 patients, 15 patients were treated via the supraorbital keyhole approach, 6 via the retrosigmoid keyhole approach, 3 via the subtemporal keyhole approach, 2 via median suboccipital approach, and 1 via the pterional keyhole approach.ResultsOf the 28 posterior cerebral circulation aneurysms, 24 aneurysms were clipped and 4 trapped; 23 aneurysms clipped completely, and 1 had residual aneurysm. Glasgow Outcome Scores at discharge revealed 25 patients had a good recovery; 1 patient was slightly disabled, and 1 patient was severely disabled. Of 15 patients treated via the supraorbital keyhole approach, to make a wider operative space, drilling of anterior clinoid process (2 patients) and posterior clinoid process (3 patients) was performed; posterior communicating artery was cut off (1 patient). For 3 patients with multiple aneurysms, complete occlusion was achieved via the same approach at one-stage.ConclusionsIndividualized keyhole approaches for posterior cerebral circulation artery aneurysms are safe and effective. The anterior clinoid process or posterior clinoid process could be drilled to offer a wide operative space for clipping. The use of multiple working windows is very helpful for controlling the parent artery and clipping the aneurysm.