Meta-Analysis of Pterional Versus Supraorbital Keyhole Approach for Clipping Intracranial Aneurysms: Direct Comparison of Approach-Related Complications

Yang, Xinyu; Wang, Weihan; Yin, Qiang; Xin, Qi-qiang; Cai, Shifei; Yang, Xinyu

doi:10.1016/j.wneu.2019.11.134

Cited by 15 publications

(16 citation statements)

References 19 publications

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“…Although the results show a significantly shorter length of ICU stay in the SOMC group, when only patients without complications during the pre-or postoperative period were analyzed, no significant difference was found between the two groups (p = 0.71), and, for this reason, the chosen craniotomy technique did not alter length of ICU stay during the postoperative period or the length of total hospital stay (p = 0.36). This result was different from the one found by Xin et al 23 , who showed a shorter length of hospital stay in the SOMC group.…”

Section: Discussioncontrasting

confidence: 99%

“…This study's results were similar to those found in a recent meta-analysis 23 in relation to the rate of complete aneurysm occlusion and chance of intraoperative rupture, with no significant differences between the two groups. Yu et al 18 also found no differences in relation to the rate of intraoperative rupture between the two groups.…”

Section: Discussionsupporting

confidence: 89%

“…In the present case series, a significant reduction was observed in operative time with SOMC, as shown by diverse authors 14,15,18 and also proven by similar results in a recent meta-analysis 23 .…”

Section: Discussionsupporting

confidence: 89%

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Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting

Fonseca

Correia

Vieira

et al. 2021

Sci Rep

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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.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 89%

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Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting

Fonseca

Correia

Vieira

et al. 2021

Sci Rep

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“…We believe that keyhole is not only the pursuit of small bone window, but the bone window that is suitable for the patient and has the least damage to the patient under su cient preoperative evaluation (CTA, CT, etc.). A previous meta-analysis of this group proved that the supraorbital lateral keyhole approach is safe and effective, which can reduce the length of hospital stay and reduce the probability of postoperative infection [7]. Statistics show that there is no signi cant difference in mortality and postoperative complications between supraorbital lateral keyhole approach and pterional approach[8] [9], and this approach can avoid supraorbital nerve, frontal branch of facial nerve, super cial temporal artery and other structures and reduce iatrogenic injury.…”

Section: Discussionmentioning

confidence: 98%

Reconstruction clipping of ruptured anterior circulation aneurysms via supraorbital lateral keyhole approach

Yuzhang

Zhao

et al. 2021

Preprint

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Background Intracranial aneurysm(IA) is a serious disease.Analyze and review the cases of anterior circulation ruptured IA by supraorbital lateral keyhole approach, and summarize the experiences of this approach. Methods Retrospective analysis of 16 cases of ruptured anterior circulation IA in our department from January 2019 to June 2020, CT angiography (CTA) was performed before operation. Analyzing the IA’s parameters by 3D-CT reconstruction. The IA was clipped by supraorbital lateral keyhole approach combined with the 3D-skull reconstruction. Extraventricular drainage were performed before craniotomy. Intraoperative neurophysiological monitoring was performed during the operation. After operation, fluorescein angiography and vascular ultrasound were performed to check the clipping effect. Intracranial pressure monitor was performed postoperatively. CTA was reexamined one week after operation. The modified Rankin Scale (MRS) was performed 6 months after operation. Results There were 7 males (43.8%) and 9 females (56.2%) ,the average age is 52.3 years. Among them, 11 patients(68.8%) were anterior communicating artery aneurysms and 5 (31.2%) were middle cerebral artery aneurysms. All patients were out of hospital within 10 days without any death, without cerebral infarction, cerebrospinal fluid leakage and neurological impairments. About mRS score, after 6 months follow-up, 8 cases(50%) had 0 point, 4 cases (25%) had 1 point, 4 cases (25%) had 2 points. Conclusions For ruptured anterior circulation IA, the supraorbital lateral keyhole approach combined with ventricular drainage, intraoperative electrophysiological monitoring and intraoperative vascular ultrasound is a safe and minimally invasive treatment. The application of reconstruction clipping can reconstruct the diameter of parent vessel and reduce the recurrence rate of IA.

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“… 17 Fischer et al, in 2011, compared different types of keyhole with pterional approach and reported comparable outcome. 18 While some comparative studies 19 20 21 have shown shorter operative time, better cosmetic outcome, less blood loss, lower craniotomy complications with keyhole approach, few studies 22 23 have cautioned on higher procedural complications and intraoperative rupture with keyhole among ruptured aneurysms. In a curious comparison of the keyhole and pterional approaches on opposite sides in the same set of patients, Park et al noted better cosmesis and satisfaction scores on the side of the keyhole but without any details on procedural complications.…”

Section: Discussionmentioning

confidence: 99%

How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

Dhandapani

Narayanan

Dhandapani

et al. 2021

JNRP

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Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

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Meta-Analysis of Pterional Versus Supraorbital Keyhole Approach for Clipping Intracranial Aneurysms: Direct Comparison of Approach-Related Complications

Cited by 15 publications

References 19 publications

Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting

Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting

Reconstruction clipping of ruptured anterior circulation aneurysms via supraorbital lateral keyhole approach

How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

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