Abstract
The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC). The results of these two techniques are compared. 35 patients underwent SOMC, compared to 50 patients underwent CP (100 aneurysms in total), using the same microsurgical instruments. The following variables were compared: operative time, angiographic cure, length of intensive care unit stay during the post-operative period, surgical complications, length of hospital stay after surgery until hospital discharge, intraoperative aneurysm rupture, aesthetic satisfaction with the scar, and neurological status at discharge. SOMC had a significantly shorter operative time in relation to PC (213.9 ± 11.09 min and 268.6 ± 15.44 min, respectively) (p = 0.0081).With respect to the cosmetic parameters assessed by the Visual Analog Scale, the average for SOMC was 94.12 ± 1.92 points, and the average for PC was 83.57 ± 4.75 points (p = 0.036). SOMC was as effective as PC in relation to successful aneurysm clipping (p = 0.77). The SOMC technique did not show advantages over PC in any other variable. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction.
Highlights
The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature
Of the microsurgical approaches to cerebral aneurysms in the anterior circulation of the circle of Willis, the pterional craniotomy (PC) technique continues to be the most used and widespread in the majority of vascular neurosurgery services around the world; this has been the case since the 1970s when Yasargil and Fox systematized this type of craniotomy, associating it with the microsurgical technique for treating cerebral a neurysms[1]
Excluding middle cerebral artery (MCA) aneurysms, which were only operated by the PC technique, a significant difference (p = 0.0315) was found in operative time, when comparing the two surgical techniques
Summary
The challenges encountered in performing minimally invasive approaches, such as supraorbital minicraniotomy (SOMC), in services without adequate equipment are rarely reported in the literature. This study analyzes the viability of SOMC in the treatment of cerebral aneurysms, using exactly the same resources as pterional craniotomy (PC) The results of these two techniques are compared. Even in a general neurosurgery service lacking a specific structure for minimally invasive surgeries, SOMC was feasible and effective for treating intracranial aneurysms, using the same set of microsurgical instruments used for PC, obtaining better results in operating time and cosmetic satisfaction. Supraorbital minicraniotomy (SOMC) with eyebrow incision has been little used in comparison with PC in approaches to anterior circulation aneurysms in general neurosurgery services, but it has begun to play an important role as one of the primary options for minimally invasive surgery for surgical treatment of lesions of the skull base. A considerably large number of conditions may be treated by means of this access, and this number tends to increase as the technique is enhanced and surgical instruments are adapted to the procedure[8,9,10]
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