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Comparison between modified lateral supraorbital approach and pterional approach in the surgical treatment of middle cerebral artery aneurysms

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Chinese Neurosurgical Journal 2018年第1期4卷 1-6页

作者： Zhouqing Chen Xiaoou Sun Tai Lu Zhengyang Lu Ming Jiang Chongshun Zhao Wanchun You Yun Zhu Zhong Wang Department of Neurosurgery The First Affiliated Hospital of Soochow University188 Shizi StreetSuzhouJiangsu Province 215006China

Background:The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings. Methods:This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant. Results: The preoperative GCS score (P=0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P=0.026), tracheotomy (P=0.014), prognosis (P=0.002) were significantly different. Different surgical approaches (P=0.002), Hunt-Hess scale (P <0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P=0.031) and complications (P < 0.001) are closely related to the prognosis of patients. Conclusions: Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.

关键词： Aneurysm clipping Middle cerebral artery aneurysms Modified lateral supraorbital approach Lateral supraorbital approach pterional approach

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Comparative analysis on microsurgical removal of craniopharyngioma via lateral supraorbital approach and standard pterional approach

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Chinese Neurosurgical Journal 2018年第3期4卷 154-161页

作者： Chongshun Zhao Zhouqing Chen Na Xu Tao Xue Xin Wu Wanchun You Yun Zhu Zhong Wang Department of Neurosurgery The First Affiliated Hospital of Soochow University188 Shizi StreetSuzhouJiangsu Province 215006China State Key Laboratory of Medical Neurobiology and Institute of Brain Sciences Fudan UniversityShanghai 200032China

Background: Craniopharyngioma is a kind of intracranial benign tumor that is primarily treated with surgery. At present, a variety of surgical approaches are used for tumor resection. We have conducted a comparative analysis of the two approaches most used in our department. Methods: The study retrospectively analyzed the clinical data from 65 patients with craniopharyngioma surgically treated by the two approaches mentioned above. Among these patients, 24 were treated by lateral supraorbital (LSO) approach and 41 by standard pterional approach. Indicators including, but not limited to, length of incision, operation time, postoperative pituitary function, urine volume, visual function improvement, and hospitalization were used to compare these two groups of patients. Results: The data shows that there was no significant difference in total tumor resection rate (P=0.54), postoperative visual field improvement (P=0.68) and postoperative function of endocrine. However, the LSO approach significantly reduced the operative incision (P=0.001), shortened the operation time (P=0.001) and operative complexity, while reducing the incidence of postoperative complications (P=0.04). Conclusions: In surgical treatment of craniopharyngioma, LSO approach has similar surgical effect with standard pterional approach, but it can significantly shorten the operation time, reduce surgical trauma and the incidence of complications. Therefore, LSO provides another alternative to surgical approach for microsurgical removal of craniopharyngioma.

关键词： Lateral supraorbital approach Standard pterional approach Craniopharyngioma

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Surgical management of clinoidal meningiomas: 10 cases analysis

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Neuroimmunology and Neuroinflammation 2018年第5期5卷 21-30页

作者： Shamsul Alam Bipin Kumar Chaurasia Narendra Shalike Abu Naim Wakil Uddin Dhiman Chowdhury Akhlaque Hossain Khan Ayub Ansari Kanak Kanti Barua Mashiur Rahman Majumder Department of Neurosurgery Bangabandhu Sheikh Mujib Medical UniversityDhaka1000Bangladesh Department of Neurosurgery Comilla Medical CollegeComilla3500Bangladesh

Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, specially their visual outcome. Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months. Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients;70.0%). Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.

关键词： Clinoidal meningiomas pterional craniotomy extradural anterior clinoidectomy

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