The Seoul National University Hospital (SNUH) said Monday its research team has found that the keyhole approach is safe and effective for multiple unruptured intracranial aneurysms (UIAs), offering a new paradigm for cerebral aneurysm treatment.
The research team, led by Professor Cho Won-sang at the Department of Neurosurgery, conducted the keyhole surgery on 493 patients from 2013 to 2018.
The researchers analyzed the complications and risk factors on 110 with multiple UIAs. As a result, the found that the ligature success rate of aneurysms was more excellent than the existing methods while reducing complications and shortening the operation time sharply, according to the hospital.
Aneurysms are vascular diseases that cause tiny ruptures on the walls of the cerebrovascular. Its prevalence rate is estimated to be at least 3 percent of the population. As the blood vessels in the brain rupture or swell, it can suppress surrounding nerve structures, causing fatal neurologic abnormalities. One of three aneurysms patients has multiple aneurysms with two to three times higher risks of rupture than single lesions.
Typical treatment methods of aneurysms include craniotomy, surgical clipping, and coil embolization. In craniotomy, the scalp and the skull are cut wide open. Through surgical clipping, the swollen cerebral aneurysms are clipped. In coil embolization, a tiny pipe is inserted through the peripheral blood vessels of arms or legs to reach cerebrovascular, filling the lesions with the coil.
With single lesions, these treatment procedures are possible after general anesthesia. However, with multiple lesions in different areas, things get more complicated. The best scenario is completing the treatment of all lesions without any complications with just one anesthesia. However, in most cases, these surgical procedures are repeated under general anesthesia. Thin increases the burden of patients concerning time, money, and risks.
The research team used a keyhole approach, minimally invasive craniotomy. Based on the fact that the keyhole approach uses holes of 3 centimeters, much smaller than the conventional approach, the keyhole approach was set in motion. Via one to three keyholes placed according to the place of lesions in different locations, the team approached lesions for successful ligation.
The treatment of multiple UIAs was successful with just one general anesthesia and skin incision. The success of the keyhole approach in single lesion patients had been reported worldwide. However, this is the first report of the success of the keyhole approach on multiple UIAs in different locations.
“Keyhole approach has overcome weaknesses of the conventional approach, reducing the chances of complications and providing the best treatment results to the patients,” Professor Cho said. “Using keyhole approach, we performed more than 1,000 times of surgical operations on aneurysms and even cavernous angioma patients. This experience will help the treatment of cerebrovascular diseases patients.”
The research result was published in the latest online edition of the Journal of Neurosurgery.