Comparative study of supraorbital keyhole approach and pterional approach in treatment of ruptured anterior communicating artery aneurysms

Abstract

Objective To compare the clinical effects of aneurysm ligation of ruptured anterior communicating artery through supraorbital keyhole approach and pterional approach. Methods We performed a retrospective study of 45 cases with anterior communicating artery aneurysms admitted to Department of Neurosurgery, Peace Hospital Affiliated to Changzhi Medical College and 29 cases with anterior communicating artery aneurysms admitted to Department of Neurosurgery, Shanxi Dayi Hospital from January 2013 to June 2018. Among them, 40 cases underwent clipping of aneurysms through pterional approach (pterional approach group) and 34 cases underwent aneurysm clipping via supraorbital keyhole approach (keyhole approach group). Clinical follow-up was performed at 6 months post surgery. The Glasgow Outcome Scale (GOS) was used for outcome assessment: grades Ⅳ-Ⅴ for good outcome, grade Ⅱ-Ⅲ for poor outcome and grade Ⅰ for death. Based on the patient's self-cosmetic satisfaction scores (1-5 points), 1 represented very dissatisfied and 5 meant very satisfied . The clinical efficacy in the 2 groups of patients was compared. Results There was no significant difference in age, gender, Hunt-Hess grade or aneurysm diameter between the 2 groups (all P>0.05). Compared with the pterional approach group, the operation time in the keyhole approach group was shorter (215.0±46.7 min vs. 272.4±50.6 min, P 0.05). However, the cosmetic satisfaction scores of patients in the keyhole approach group was higher than those in the pterional approach group (4.8±0.6 vs. 3.9±1.1, P<0.01). Conclusions The keyhole approach is a safe and reliable surgical approach, ruptured anterior communicating artery aneurysm, the supraorbital approach can be partly used to replace the pterional approach. Key words: Intracranial aneurysm; Treatment outcome; Anterior artery; Supraorbital keyhole approach; Pterional approach