Abstract
Microneurosurgical techniques introduced by Prof. Yaşargil have been modified by the senior author (JH) when treating more than 4,000 patients with aneurysms at two of the Departments of Neurosurgery in Finland, Kuopio and Helsinki, with a total catchment area of close to three million people. This experience is reviewed, and the treatment of anterior circulation aneurysms by simple, fast, normal anatomy preserving strategy is presented.
Most of the aneurysms of the anterior circulation are treated by using the lateral supraorbital approach, a less invasive, more frontally located modification of the pterional approach. To avoid extensive skull base surgery, a slack brain is needed and achieved by experienced neuroanesthesia and by surgical tricks for removal of CSF.
Diagnosis of cerebral aneurysm before rupture improves treatment results more than any technical advances. Until this is realized, we continue to treat cerebral aneurysms by simple, fast, preserving normal anatomy-strategy, which has served our patients well.
Patients with cerebral aneurysms should be treated at specialized neurovascular centers.
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References
Guglielmi G, Vinuela F, Sepetka I, Macellari V (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:1–7
Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14
Meisel HJ, Rodesch G, Alvarez H, Lasjaunias P, Brock M (1995) Use of GDC coils in treatment of inoperable aneurysms: report of initial experiences. Zentralbl Neurochir 56:27–33
Moret J (1991) Endovascular treatment of berry aneurysms by endosaccular occlusion. Acta Neurochir Suppl 53:48–49
Serbinenko FA (1974) Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145
Yaşargil MG (1996) Surgical approaches. In: Yaşargil MG (ed) Microneurosurgery. Microneurosurgery of CNS tumors. George Thieme Verlag, New York Stuttgart, pp 29–68
Yaşargil MG (1984) General operative techniques. In: Yaşargil MG (ed) Microneurosurgery. Thieme-Stratton, New York, pp 208–233
Yaşargil MG (1969) Microsurgery applied to neurosurgery. Georg Thieme, Stuttgart, pp 105–115
Hernesniemi J, Niemelä M, Karatas A, Kivipelto L, Ishii K, Rinne J, Ronkainen A, Koivisto T, Kivisaari R, Shen H, Lehecka M, Frösen J, Piippo A, Jääskeläinen JE (2005) Some collected principles of microneurosurgery: simple and fast, while preserving normal anatomy: a review. Surg Neurol 64:195–200
Hernesniemi J, Niemelä M, Dashti R, Karatas A, Kivipelto L, Ishii K, Rinne J, Ronkainen A, Pelaez JG, Koivisto T, Kivisaari R, Shen H, Lehecka M, Frösen J, Piippo A, Avci E, Jääskeläinen JE (2006) Principles of microneurosurgery for safe and fast surgery. Surg Technol Int 15:305–310
Hernesniemi J, Ishii K, Niemelä M, Smrcka M, Kivipelto L, Fujiki M, Shen H (2005) Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl 94:17–21
Randell T, Niemelä M, Kyttä J, Tanskanen P, Määttänen M, Karatas A, Ishii K, Dashti R, Shen H, Hernesniemi J (2006) Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage: The Helsinki experience. Surg Neurol 66:382–388
Hernesniemi J (2001) Mechanisms to improve treatment standards in neurosurgery, cerebral aneurysm surgery as example. Acta Neurochir Suppl 78:127–134
Hernesniemi J, Romani R, Niemelä M (2009) Skull base and aneurysm surgery. Surg Neurol 71:30–31
Hernesniemi J, Dashti R, Lehecka M, Niemelä M, Rinne J, Lehto H, Ronkainen A, Koivisto T, Jääskeläinen JE (2008) Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol 70:8–28
Dashti R, Hernesniemi J, Lehto H, Niemelä M, Lehecka M, Rinne J, Porras M, Ronkainen A, Phornsuwannapha S, Koivisto T, Jääskeläinen JE (2007) Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol 68:366–377
Dashti R, Hernesniemi J, Niemelä M, Rinne J, Lehecka M, Shen H, Lehto H, Albayrak BS, Ronkainen A, Koivisto T, Jääskeläinen JE (2007) Microneurosurgical management of distal middle cerebral artery aneurysms. Surg Neurol 67:553–563
Dashti R, Hernesniemi J, Niemelä M, Rinne J, Porras M, Lehecka M, Shen H, Albayrak BS, Lehto H, Koroknay-Pal P, de Oliveira RS, Perra G, Ronkainen A, Koivisto T, Jääskeläinen JE (2007) Microneurosurgical management of middle cerebral artery bifurcation aneurysms. Surg Neurol 67:441–456
Dashti R, Rinne J, Hernesniemi J, Niemelä M, Kivipelto L, Lehecka M, Karatas A, Avci E, Ishii K, Shen H, Pelaez JG, Albayrak BS, Ronkainen A, Koivisto T, Jääskeläinen JE (2007) Microneurosurgical management of proximal middle cerebral artery aneurysms. Surg Neurol 67:6–14
Lehecka M, Dashti R, Hernesniemi J, Niemelä M, Koivisto T, Ronkainen A, Rinne J, Jääskeläinen J (2008) Microneurosurgical management of aneurysms at the A2 segment of anterior cerebral artery (proximal pericallosal artery) and its frontobasal branches. Surg Neurol 70:232–246
Lehecka M, Dashti R, Hernesniemi J, Niemelä M, Koivisto T, Ronkainen A, Rinne J, Jääskeläinen J (2008) Microneurosurgical management of aneurysms at A3 segment of anterior cerebral artery. Surg Neurol 70:135–151
Lehecka M, Dashti R, Hernesniemi J, Niemelä M, Koivisto T, Ronkainen A, Rinne J, Jääskeläinen J (2008) Microneurosurgical management of aneurysms at A4 and A5 segments and distal cortical branches of anterior cerebral artery. Surg Neurol 70:352–367
Lehecka M, Lehto H, Niemelä M, Juvela S, Dashti R, Koivisto T, Ronkainen A, Rinne J, Jääskeläinen JE, Hernesniemi JA (2008) Distal anterior cerebral artery aneurysms: treatment and outcome analysis of 501 patients. Neurosurgery 62:590–601
Lehecka M, Niemelä M, Seppanen J, Lehto H, Koivisto T, Ronkainen A, Rinne J, Sankila R, Jääskeläinen J, Hernesniemi J (2007) No long-term excess mortality in 280 patients with ruptured distal anterior cerebral artery aneurysms. Neurosurgery 60:235–240
Frösen J, Piippo A, Paetau A, Kangasniemi M, Niemelä M, Hernesniemi J, Jääskeläinen J (2006) Growth factor receptor expression and remodeling of saccular cerebral artery aneurysm walls: implications for biological therapy preventing rupture. Neurosurgery 58:534–541
Frösen J, Piippo A, Paetau A, Kangasniemi M, Niemelä M, Hernesniemi J, Jääskeläinen J (2004) Remodeling of saccular cerebral artery aneurysm wall is associated with rupture: histological analysis of 24 unruptured and 42 ruptured cases. Stroke 35:2287–2293
Frösen J, Marjamaa J, Myllarniemi M, Abo-Ramadan U, Tulamo R, Niemelä M, Hernesniemi J, Jääskeläinen J (2006) Contribution of mural and bone marrow-derived neointimal cells to thrombus organization and wall remodeling in a microsurgical murine saccular aneurysm model. Neurosurgery 58:936–944
Helgadottir A, Thorleifsson G, Magnusson KP, Gretarsdottir S, Steinthorsdottir V, Manolescu A, Jones GT, Rinkel GJ, Blankensteijn JD, Ronkainen A, Jääskeläinen JE, Kyo Y, Lenk GM, Sakalihasan N, Kostulas K, Gottsater A, Flex A, Stefansson H, Hansen T, Andersen G, Weinsheimer S, Borch-Johnsen K, Jorgensen T, Shah SH, Quyyumi AA, Granger CB, Reilly MP, Austin H, Levey AI, Vaccarino V, Palsdottir E, Walters GB, Jonsdottir T, Snorradottir S, Magnusdottir D, Gudmundsson G, Ferrell RE, Sveinbjornsdottir S, Hernesniemi J, Niemelä M, Limet R, Andersen K, Sigurdsson G, Benediktsson R, Verhoeven EL, Teijink JA, Grobbee DE, Rader DJ, Collier DA, Pedersen O, Pola R, Hillert J, Lindblad B, Valdimarsson EM, Magnadottir HB, Wijmenga C, Tromp G, Baas AF, Ruigrok YM, van Rij AM, Kuivaniemi H, Powell JT, Matthiasson SE, Gulcher JR, Thorgeirsson G, Kong A, Thorsteinsdottir U, Stefansson K (2008) The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet 40:217–224
Laaksamo E, Tulamo R, Baumann M, Dashti R, Hernesniemi J, Juvela S, Niemelä M, Laakso A (2008) Involvement of mitogen-activated protein kinase signaling in growth and rupture of human intracranial aneurysms. Stroke 39:886–892
Tulamo R, Frösen J, Junnikkala S, Paetau A, Pitkaniemi J, Kangasniemi M, Niemelä M, Jääskeläinen J, Jokitalo E, Karatas A, Hernesniemi J, Meri S (2006) Complement activation associates with saccular cerebral artery aneurysm wall degeneration and rupture. Neurosurgery 59:1069–1076
van der Voet M, Olson JM, Kuivaniemi H, Dudek DM, Skunca M, Ronkainen A, Niemelä M, Jääskeläinen J, Hernesniemi J, Helin K, Leinonen E, Biswas M, Tromp G (2004) Intracranial aneurysms in Finnish families: confirmation of linkage and refinement of the interval to chromosome 19q13.3. Am J Hum Genet 74:564–571
Weinsheimer S, Goddard KA, Parrado AR, Lu Q, Sinha M, Lebedeva ER, Ronkainen A, Niemelä M, Khusnutdinova EK, Khusainova RI, Helin K, Jääskeläinen JE, Sakovich VP, Land S, Kuivaniemi H, Tromp G (2007) Association of kallikrein gene polymorphisms with intracranial aneurysms. Stroke 38:2670–2676
Drake CG, Peerless SJ, Hernesniemi J (1995) Surgery of vertebrobasilar aneurysms: London, Ontario experience on 1767 patients. In: Peerless SJ, Hernesniemi JA (eds) Multiple aneurysms. Springer, London
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Romani, R. et al. (2010). Microsurgical Principles for Anterior Circulation Aneurysms. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_1
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DOI: https://doi.org/10.1007/978-3-211-99373-6_1
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