Neuronavigation-assisted microsurgical operation via keyhole approaches for distal intracranial artery aneurysms

Objective To investigate the value of neuronavigation system in the keyhole microsurgical operation for distal intracranial artery aneurysms(DIAA). Methods The clinical data of 16 cases with DIAA who were treated by via keyhole approaches, from January, 2013 to December, 2018, were analyzed retrospectively. Ten aneurysms located in anterior cerebral artery(ACA), 3 in posterior inferior cerebellum artery(PICA) and 3 in perforator artery(PA). The optimal skin incision and craniotomy were designed with assistence of neuronavigation system preoperatively, and lesions were located precisely under the guidance of neuronavigation system during microsurgery before clipping or resection. Angiography was performed before discharge, and clinic followed-up was conducted monthly till 6 months after surgery. Results The systematic error of neuronavigation system ranged from 0.5 mm to 1.0 mm, with an average of 0.6 mm. All 16 aneurysms were explored and managed successfully with the guidance of neuronavigation system without aneurysm premature rupture nor neuronavigation-related complications. Absolute occlusion of all aneurysms was documented angiographically after surgery. Of all cases, 2 experienced shunt procedure due to delayed hydrocephalus. During 6 months follow-up period, all 16 cases recovered well. Conclusion Neuronavigation system can precisely locate the deep-seated DIAA, contribute to the preoperative planning of microsurgery via keyhole approaches and avoid evitable injury during excessive manipulation. The noninvasive, rapid and contrast-enhanced CT images of head was an ideal data source for the neuronavigation system. Key words: Intracranial aneurysm; Surgical approach; Keyhole; Neuronavigation; Microsurgical operation