Lateral Supraorbital Approach for the Surgical Clipping of Ruptured Tiny Anterior Circulation Aneurysms.

Objective: To evaluate the efficacy and usefulness of clipping procedure by lateral supraorbital approach for tiny anterior circulation aneurysms.

Study Design: An observational study.

Place And Duration Of Study: Department of Neurosurgery, The Second Hospital of Anhui Medical University, Hefei, Anhui Province, China, from January 2013 to March 2018.

Methodology: Thirty-eight patients who had suffered aneurysm rupture, resulting in subarachnoid hemorrhage, were selected. Fourty-four very small aneurysms with a maximum diameter of ≤3 mm that presented different configurations, were identified using digital subtraction angiography (DSA). Clinical data of patients, including clinical information, microsurgery procedure, procedural complications, clinical outcomes, and follow-up were analysed.

Results: All ruptured aneurysms involved the anterior circulation, located in middle cerebral artery (19/38), anterior communicating artery (10/38), posterior communicating artery (6/38), anterior choroidal artery (2/38), and ophthalmic artery (1/38). Complete occlusions were achieved in all of the lesions by surgical clipping via the lateral supraorbital approach. There were no intra-procedural ruptures or procedure-related vasospasm, epilepsy, hydrocephalus. Glasgow outcome scale (GOS) scores showed that 34 patient (86.84%) had good outcomes (GOS 4-5) at the time of discharge. There was no residual neck or recurrence following computed tomography angiography (CTA) and DSA at follow-up in 20 cases.

Conclusion: Surgical clipping via lateral supraorbital approach presented a low rate of adverse events related to the procedure, and was safe and effective in ruptured tiny aneurysms. Key Words: Tiny aneurysm; Surgical clipping; Clinical outcome; Lateral supraorbital approach.