Single-centre Microsurgery Treatment Methods for Unruptured Intracranial Aneurysms of the Anterior Circulation and Results

Abstract

Objective:Intracranial artery aneurysms can result in high morbidity and mortality when ruptured. Preventive treatments might be necessary to avoid adverse results. This paper aims to discuss and share the first-term findings of unruptured intracranial artery aneurysms (UIAs) of the anterior circulation surgery at a newly established clinic in light of our clinical principles and surgical approaches.Method:Patients diagnosed with UIAs of the anterior circulation in our establishment in September 2020 and November 2022 and treated with microsurgery clipping operations were retrospectively evaluated. Assistive devices such as a sodium fluorescein integrated microscope, videoangiography, and micro-Doppler ultrasonography were intraoperatively used. We actively used a second surgeon with a third hand in the microscopic field. With case studies, we provided various techniques, and our experiences were used to avoid complications. We compared our surgical findings with radiological and clinical data.Results:In our institution, 44 aneurysms and 40 patients diagnosed with UIAs of the anterior circulation were treated with 42 operations. The mean age was 50 years (31/69 years), and the follow-up time was 379 days (30/828 days). The modified Rankin scale (mRS) of the patients was evaluated; the mRS of patients was evaluated as three due to previous subarachnoid haemorrhage history, and postoperative change was not detected. Three patients had postoperative epileptic seizures; therefore, their mRS was evaluated as 1, and the mRS of 36 patients was 0 after follow-up. In the postoperative digital subtraction angiography of two patients, a rest was detected in the aneurysm neck; therefore, one patient underwent another surgery, and the endovascular team treated the other patient. Infarction due to loss of the parent artery and the perforating artery was not observed in any patient. Minor complications were seen in 20% of the patients.Conclusion:An increase in the variety and use of intraoperative assistive techniques and the active participation of the second surgeon using a third hand can decrease the complication rate. Additionally, the complication rate will decrease as the surgical experience increases in vascular institutions dealing with such cases.

Keywords

• aneurysm clipping
• micro-doppler ultrasonography
• microsurgery
• sodium fluorescein
• videoangiography