Abstract
Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.Material and methods. We made a comparison of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on in the period from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; the second group patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics.
Highlights
Результаты Заключение Ключевые слова: Цитировать: Сравнительный анализ использования минимально инвазивных (МиД) и традиционных (ТрД) доступов при микрохирургическом лечении неразорвавшихся церебральных аневризм (НЦА) для оценки эффективности и безопасности концепции keyhole-хирургии
We made a comparison of the microsurgical treatment outcomes of 204 patients harbouring unruptured intracranial aneurysms (UIAs) who were operated on in the period from 2014 to 2019
Удовлетворенность пациента косметическими результатами операции по косметической визуально-аналоговой шкале, балла
Summary
Результаты Заключение Ключевые слова: Цитировать: Сравнительный анализ использования минимально инвазивных (МиД) и традиционных (ТрД) доступов при микрохирургическом лечении неразорвавшихся церебральных аневризм (НЦА) для оценки эффективности и безопасности концепции keyhole-хирургии. В группе ТрД использовали птериональный (n = 31), орбитозигоматический (n = 16) и латеральный супраорбитальный (n = 38) доступы. В группе МиД применяли трансбровный супраорбитальный (n = 35), мини-птериональный (n = 38), трансбровный трансорбитальный (n = 20) и транспальпебральный трансорбитальный (n = 26) доступы. Длительность госпитализации достоверно меньше в группе мини-доступов (р > 0,001). Функциональные исходы сопоставимы в обеих группах (р > 0,05), а косметические исходы достоверно лучше в группе МиД (р < 0,05). Микрохирургическое лечение пациентов с НЦА из минимально инвазивных доступов является эффективным и безопасным. Сравнительный анализ использования минимально инвазивных и традиционных доступов в микрохирургическом лечении неразорвавшихся церебральных аневризм Виллизиева круга.
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