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. 2012:3:156.
doi: 10.4103/2152-7806.105095. Epub 2012 Dec 26.

Benefits of early aneurysm surgery: Southern Iran experience

Abdolkarim Rahmanian  1 , Mohammad Jamali, Ali Razmkon, Juri Kivelev, Rossana Romani, Ehsan-Ali Alibai, Juha Hernesniemi
Affiliations

Benefits of early aneurysm surgery: Southern Iran experience

Abdolkarim Rahmanian et al. Surg Neurol Int. 2012.

Abstract

Background: Neurovascular surgery has been practiced in Shiraz, the main referral center of the Southern Iran, for over 30 years; however, the trend has accelerated tremendously in recent years following subspecialization of neurovascular surgery in Shiraz, Department of Neurosurgery. Over 100 patients are operated each year, and nearly all are addressed during the first 72 hours after presentation.

Methods: In this paper, we focus on the description of techniques we apply for early clipping of ruptured intracranial aneurysms in the anterior circulation. Improvements in outcome, mortality, and rebleeding rates are also discussed.

Results: Mortality and rebleeding rates have declined significantly since the institution of new techniques.

Conclusion: The establishment of early surgery for ruptured anterior circulation aneurysms through the lateral supraorbital approach along with specific anesthetic protocol has resulted in significant improvement of morbidity, mortality, and rebleeding rates at our department.

Keywords: Anterior circulation; early surgery; ruptured aneurysm; techniques.

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Figures

Figure 1
Figure 1
Patient's position during the lateral supraorbital approach. A roll is placed under the shoulder to provide a suitable position for the head above cardiac level. We perform skull fixation in the three-point fixator frame, and provide 15°–30° of head rotation with slight lateral tilting and extension
Figure 2
Figure 2
An 8-10 cm frontotemporal skin incision is outlined by a surgical marker 1 cm behind the hairline until 2-3 cm above the zygomatic arch
Figure 3
Figure 3
The temporalis muscle is incised not more than 1.5-2 cm in length, and it is elevated with the skin as a single one-layer flap. We use fishhooks for retraction of the flap to the front. A single bur hole is placed under the superior temporal line
Figure 4
Figure 4
A 3 by 4 cm free bone flap is elevated by craniotomy
Figure 5
Figure 5
Postoperative three-dimensional CT scan of a patient who underwent the lateral supraorbital approach. Note the small size of the craniotomy and its relation to anatomic landmarks
See this image and copyright information in PMC

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