Superficial Temporal Artery-Sparing Mini-Pterional Approach for Cerebral Aneurysm Surgery

Abstract

ObjectiveThe purposes of this study were to introduce a superficial temporal artery (STA)-sparing mini-pterional approach for the treatment of cerebral aneurysms and review the surgical results of this approach.MethodsBetween June 2010 and December 2015, we performed the STA-sparing mini-pterional approach for 117 patients with 141 unruptured intracranial aneurysms. We analyzed demographic, radiologic, and clinical variables including age, sex, craniotomy size, aneurysm location, height of STA bifurcation, and postoperative complications.ResultsThe mean age of patients was 58.4 years. The height of STA bifurcation from the superior border of the zygomatic arch was 20.5 mm±10.0 (standard deviation [SD]). The craniotomy size was 1051.6 mm2±206.5 (SD). Aneurysm neck clipping was possible in all cases. Intradural anterior clinoidectomy was performed in four cases. Contralateral approaches to aneurysms were adopted for four cases. Surgery-related complications occurred in two cases. Permanent morbidity occurred in one case.ConclusionOur STA-sparing mini-pterional approach for surgical treatment of cerebral aneurysms is easy to learn and has the advantages of small incision, STA sparing, and a relatively wide surgical field. It may be a good alternative to the conventional pterional approach for treating cerebral aneurysms.

Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms

“…In total, 5423 articles were screened, of which 114 articles met the eligibility criteria for this review (eFigure 1 and eTables 2-4 in the Supplement). For EVT, we included 74 studies that included 71 819 patients with 73 066 aneurysms (eTable 3 in the Supplement) and for NST, we included 54 studies with a total of 34 614 patients with 35 197 aneurysms (eTable 4 in the Supplement). Fourteen of 114 studies (12.3%), with a tot...…”

“…Details of the included studies are given in Table 1 and eTables 3 and 4 in the Supplement. Most of the studies had a retrospective design (68 EVT studies [92%] with 71 098 patients; 53 NST studies [98%] with 34 543 patients) and were single-center cohorts (52 EVT studies [70%] with 14 444 patients; 40 NST studies [74%] with 9589 patients; Table 1). Of the 114 studies, 15 EVT studies (20%) with 10 412 patients and 11 NST studies (18%) with 4059 patients were of high methodological quality.…”

“…Among 74 EVT studies, 59 (80%) with 16 000 patients reported separately on intracranial ischemic complications and 58 (78%) with 18 520 patients on hemorrhagic complications, and 17 (23%) with 2248 patients reported on advanced endovascular methods only. Among 54 NST studies, ischemic complications were reported separately in 33 studies (61%) with 12 691 patients and hemorrhagic complications in 36 studies (67%) with 10 545 patients. Most studies originated from Asia (38 EVT studies [51%] with 18 942 patients and 29 NST studies…”

“…Among 54 NST studies, ischemic complications were reported separately in 33 studies (61%) with 12 691 patients and hemorrhagic complications in 36 studies (67%) with 10 545 patients. Most studies originated from Asia (38 EVT studies [51%] with 18 942 patients and 29 NST studies [54%] with 7870 patients) and North America (25 EVT studies [34%] with 51 296 patients and 15 NST studies [28%] with 25 247 patients). Data on patient and aneurysm characteristics were available for a subset of studies (Table 1).…”

Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization

“…The majority of clipping surgeries for unruptured aneurysms were performed using a superficial temporal artery (STA)-sparing mini-pterional approach introduced by our institute. 1) Standard or extended pterional approaches were used for ruptured or anatomically difficult lesions, while an interhemispheric approach was used for distal anterior cerebral artery (ACA) lesions, and a far lateral approach for any vertebral artery -posterior inferior cerebellar artery (VA-PICA) lesions.…”