Supraorbital keyhole versus pterional craniotomies for ruptured anterior communicating artery aneurysms: a propensity score–matched analysis
- 48 Downloads
The safety and efficacy of the supraorbital keyhole approach for aneurysm surgery have not been well researched through a high-quality controlled study. The objective of the study was to compare the safety and efficacy of the supraorbital and pterional approaches for ruptured anterior communicating aneurysm (AComAn). A total of 140 patients, with 70 patients in each group, were enrolled after 1:1 propensity score matching. Clinical variables, postoperative complications, and long-term outcomes were retrospectively compared. Baseline characteristics were equivalent between the two groups. Significantly shorter operative time and less intraoperative blood loss were observed in the supraorbital group compared to the pterional group (141.9 min vs. 184.5 min, P < 0.001; 160.4 ml vs. 250.7 ml, P = 0.008). The incidence of intraoperative aneurysm rupture was similar between the groups (20% vs. 18.6%, P = 0.830). The rate of procedural complications involving subdural hematoma and intracranial infection was lower in patients treated through the supraorbital (10.0%) vs. the pterional approach (32.9%, P < 0.001), but no significant difference was observed for the incidence of ischemic events (15.7% vs. 18.6%, P = 0.654). Within a median 33.4-month (range, 11–67 months) follow-up, a similar proportion of patients achieved a favorable outcome (Glasgow Outcome Scale IV or V) across the two groups (83.6% vs. 80.0%, P = 0.285), while better cosmetic results were observed in the supraorbital group (94.0%) vs. the pterional group (86.2%, P = 0.129). According to our results, we recommend the keyhole approach for AComAn surgery for neurosurgeons who have gained sufficient experience with this technique due to its advantages over the pterional approach.
KeywordsAComAn Rupture Pterional Supraorbital
This work received financial support from the China National Clinical Research Center for Neurosurgical Diseases (NCRC-ND) (2015BAI12B04).
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
The current study was approved by the ethical committee of our hospital.
Informed consent was obtained for all enrolled patients.
- 4.Chalouhi N, Jabbour P, Ibrahim I, Starke RM, Younes P, El Hage G, Samaha E (2013) Surgical treatment of ruptured anterior circulation aneurysms: comparison of pterional and supraorbital keyhole approaches. Neurosurgery 72:437–441; discussion 441-432. https://doi.org/10.1227/NEU.0b013e3182804e9c CrossRefPubMedGoogle Scholar
- 6.Deng X, Gao F, Zhang D, Zhang Y, Wang R, Wang S, Cao Y, Zhao Y, Pan Y, Liu X, Zhang Q, Zhao J (2018) Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score-matched analysis. J Neurosurg 128:1785–1791. https://doi.org/10.3171/2017.2.jns162405 CrossRefPubMedGoogle Scholar
- 8.Fischer G, Stadie A, Reisch R, Hopf NJ, Fries G, Bocher-Schwarz H, van Lindert E, Ungersbock K, Knosp E, Oertel J, Perneczky A (2011) The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery 68:45–51; discussion 51. https://doi.org/10.1227/NEU.0b013e31820934ca CrossRefPubMedGoogle Scholar
- 15.Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet (London, England) 360:1267–1274CrossRefGoogle Scholar
- 16.Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet (London, England) 366:809–817. https://doi.org/10.1016/s0140-6736(05)67214-5 CrossRefGoogle Scholar
- 21.Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscara C, Scotti M, Romito R, Mariani L, Mazzaferro V (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880. https://doi.org/10.1002/bjs.10137 CrossRefPubMedGoogle Scholar
- 23.Wang H, Luo L, Ye Z, Li W, Chen C, Ba Y, Ning X, Guo Y (2015) Clipping of anterior communicating artery aneurysms in the early post-rupture stage via transorbital keyhole approach--Chinese neurosurgical experience. Br J Neurosurg 29:644–649. https://doi.org/10.3109/02688697.2015.1023774 CrossRefPubMedGoogle Scholar