Neurosurgical "Squeeze Play": Single Incision with Dual Ipsilateral Craniotomies Versus 2 Separate Approaches for Intracranial Aneurysm Treatment

Authors

Jan-Karl Burkhardt, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Ali S. Haider, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
W Caleb Rutledge, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.Follow
Doris Wang, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Lisa Hannegan, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
Michael T. Lawton, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA; Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: Michael.Lawton@BarrowBrainandSpine.com.Follow

Document Type

Article

Abstract

OBJECTIVE: Patients with bilateral, multiple intracranial aneurysms (IA) can be safely treated using 1 lateral craniotomy. However, in patients with an additional pericallosal artery (PcaA) or distal anterior cerebral artery (ACA) aneurysm, an interhemispheric approach through a bifrontal craniotomy is needed. We investigated the safety of a single incision with dual ipsilateral craniotomies ("squeeze play") and compared results with 2 separate staged surgeries. METHODS: Retrospective data collection and analysis was performed of all cases of multiple IAs including a PcaA or complex ACA aneurysm between 1997 and 2016. Univariate statistical analysis was performed to compare radiologic and clinical outcomes. RESULTS: Both the squeeze play group (n = 12) and the control group (n = 16) showed similar female gender and mean age distribution, with a higher mean aneurysm number in the squeeze play group. Indication for surgery was mainly subarachnoid hemorrhage (SAH) for the control group (12/16). Mean aneurysm diameter of the largest aneurysm treated with the lateral craniotomy was higher in the squeeze play group (15.8 vs. 4.7 mm, P = 0.005), with comparable craniotomy types between both groups. Cumulative estimated blood loss was higher in the control group, with a comparable cumulative operating room time, reoperation rate, and favorable clinical outcome in both groups. CONCLUSIONS: Single-staged surgery with a single incision and dual ipsilateral craniotomies is a safe treatment for multiple unruptured aneurysms that include PcaA and distal ACA aneurysms. The squeeze play results in clinical and radiologic outcomes comparable with those in a 2-staged control group. In the setting of SAH, 2-staged surgery with a recovery interval is preferred to prevent bilateral manipulation of the acutely injured brain.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Blood Loss, Surgical (statistics & numerical data); Brain Injuries (surgery); Craniotomy (methods); Female; Humans; Intracranial Aneurysm (surgery); Male; Middle Aged; Retrospective Studies; Subarachnoid Hemorrhage (surgery)

Publication Date

8-22-2017

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

107

First Page

554

Last Page

558

PubMed ID

28823661

Digital Object Identifier (DOI)

10.1016/j.wneu.2017.08.032

Recommended Citation

Burkhardt, Jan-Karl; Haider, Ali S.; Rutledge, W Caleb; Wang, Doris; Hannegan, Lisa; and Lawton, Michael T., "Neurosurgical "Squeeze Play": Single Incision with Dual Ipsilateral Craniotomies Versus 2 Separate Approaches for Intracranial Aneurysm Treatment" (2017). Neurosurgery. 1212.
https://scholar.barrowneuro.org/neurosurgery/1212