Lifewatch: Eyelid craniotomy

Reported by Claire Hosmann - email
Posted by Debra Worley - email

**Disclaimer: The video to the right contains graphic image.

(WECT) - Brain aneurysms are estimated to happen up to one in 15 people across the nation at some time in their lifetime.

Brain Surgery typically goes along with large scars and lengthy recoveries, but now doctors are using the eyes as the gateway to the brain to make surgery less invasive.

Through a CAT scan, doctors determined Mike Hogan had an aneurysm in danger of rupturing.  Hogan's surgeons used a new and unusual technique to treat it.

"When we do the standard procedure we make an incision behind the hairline -- from here, all the way to here," said neurosurgeon Dr. Khaled Aziz.

Instead, surgeons fixed the aneurysm through a tiny hole in his eyelid.

During the eyelid craniotomy a neuro-opthomologist marks the eyelid crease then makes an incision and removes a small piece of bone from the patient's eye socket.

Next, a neurosurgeon reaches the front of the brain, clips the blood vessel that feeds the aneurysm and then puts the bone back in place.

Doctors say a smaller incision means a shorter hospital stay, faster recovery, and less pain.

Dr. Aziz said the eyelid approach is not for every patient.  It only works for patients who need brain surgery toward the front of the skull.

Neurosurgeons also use the technique to operate on certain brain tumors.

For more information, please contact:
Dan Laurent
Media Relations
West Penn Allegheny Health System
(412) 359-8602

BACKGROUND: A brain aneurysms is a bulging vessel in the brain that is filled with blood. According to the American Society of Interventional and Therapeutic Neuroradiology, they are estimated to happen in up to one in 15 people across the nation at some time in their lifetime. Women have a slightly higher risk than men of developing a brain aneurysm. Aneurysms can put pressure on nerves or surrounding brain tissue. They often go undetected until they burst, which causes bleeding in the brain. This is referred to as a subarachnoid hemorrhage and can lead to complications like stroke, permanent brain damage and even death. More than 30,000 people across the nation suffer these types of hemorrhages.

TREATMENT: Sometimes aneurysms are detected and treated before they rupture with surgery or minimally-invasive endovascular coiling. Surgical treatment of aneurysms involves a craniotomy, or removing a portion of the skull. Surgeons stop blood flow to the aneurysm using a tiny metal clip. The bone is then replaced and the incision is closed. The endovascular option is a minimally invasive procedure. The aneurysm is first assessed by inserting a catheter into an artery in the patient's leg and into the head. Tiny platinum coils are threaded through the catheter into aneurysm until all of the space inside it is full. The coils blocks blood flow and prevent a rupture. More than 125,000 patients around the world have been treated with this method. Studies have found many benefits of the minimally invasive treatment over the surgical method. For example, it cuts hospital time in half, reduces the likelihood of new symptoms and disability following treatment, and shortens recovery time from one year to, in some instances, just 27 days. The main goal of treatment after an aneurysm ruptures is to stop the bleeding and prevent brain damage. Subarachnoid hemorrhage patients are treated as soon as possible using the same techniques performed for an unruptured aneurysm: coiling and clipping.

EYELID APPROACH: Surgeons at Allegheny General Hospital (AGH) in Pittsburgh, Pa.. are using a new procedure to fix life-threatening brain aneurysms. Instead of making a major incision in the forehead, they are taking a much less invasive approach by making an incision in the eyelid crease. AGH is just one of two hospitals in the United States to offer the procedure on patients who have an aneurysm that have become problematic or are at risk of rupturing. The procedure involves two steps. In the first part, the incision is made and a small piece of bone from the patient's upper eye socket is removed. The second part is a delicate process where the aneurysm is clipped and isolated from the cerebral circulation. It takes about four hours to complete the entire procedure.

The eyelid technique offers many advantages over the traditional methods. According to Khaled Aziz, M.D., director of AGH's Center for Complex Intracranial Surgery, it reduces surgical orbidity and allows for a faster recovery. Patients are able to leave the hospital in just a few days, and because of the location of the incision, the appearance of scars is minimized. Dr. Aziz says the eyelid incision technique is especially ideal for patients with aneurysms located in the front area of the brain and can also be used for cysts and brain tumors.

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