Unilateral Lateral Supraorbital Approach To Clip Bilateral Anterior Circulation Intracranial Aneurysms Case Series And Literature Review

BackgroundFor patients with bilateral anterior circulation aneurysms, traditional operation strategies were (1) two-stage operation-clipping the ruptured aneurysm firstly or (2) one-stage through bilateral craniotomies. In theory, it would simplify the procedures if anterior circulation aneurysms on both sides could be clipped by unilateral approach. And patients would avoid the risk of repeat craniotomies and anesthesia. Currently, several literatures have mentioned unilateral pterional approach for bilateral intracranial aneurysms clipping. By contrast, lateral supraorbital approach may be a good alternative for bilateral aneurysms on the advantage of more mini-invasive, convenient and well-favored.MethodA total of32patients with bilateral anterior circulation aneurysms were treated in the second affiliated hospital of Zhejiang university school of medicine. They were divided into Group A, in which the aneurysms were clipped through unilateral lateral supraorbital approach, and Group B, in which patients may need another craniotomy. Information about gender, age, Hunt&Hess grade score, size and location of aneurysms, operation time, hospitalization time, GOS before discharge and the complications was obtained. Safety and efficacy of LSO approach to clip bilateral aneurysms were assessed, as well as the influence of Hunt&Hess grad, size and location of aneurysms on the short outcome. Then, unilateral approach for bilateral lesions was reviewed.ResultGender, age, Hunt&Hess grade, size and location of aneurysms, operation and hospitalization time, GOS before discharge showed no significant distinction between Group A and Group B. And they shared similar residual aneurysms as well as complications. Hunt&Hess grade, location of aneurysms may be associated with short outcome of Group A. Unilateral pterional approach was the most popular strategy for bilateral aneurysms.ConclusionAs a mini-invasive, convenient and well-favored procedure, LSO approach to clip bilateral aneurysms may be safe and effective. Hunt&Hess grade, location and direction of aneurysms as well as intracranial condition may be associated with short outcome. It may be worthful to generalize Unilateral LSO approach for multiple intracranial aneurysms.