The minipterional approach for ruptured and unruptured anterior circulation aneurysms: Our initial experience

Abstract

Objective:To report our experience with the minipterional (MPT) craniotomy approach for anterior circulation aneurysms and to discuss the clinical outcomes as well as to evaluate the advantages of this unique approach.Materials and Methods:Single-center retrospective review of 57 cases involving anterior circulation aneurysms both ruptured and unruptured aneurysms treated with the MPT. We analyzed the clinical and patient demographic data, aneurysm characteristics, surgical outcomes, and complications in these individuals.Results:Between July 2008 and March 2014, of the 57 patients reviewed: 45 had middle cerebral artery (MCA), 6 had internal carotid artery terminus, and 7 had posterior communicating artery aneurysms. 20 of the 57 patients presented with a ruptured aneurysm. The average aneurysm size was 5.8 mm. The length of hospitalization for unruptured aneurysm cases ranged between 3 and 5 days. The average follow-up for all cases was 21.5 months. Successful clipping of the aneurysms was obtained in all patients. None of the cases required additional skin incisions or craniotomy extensions. The overall surgical outcomes were favorable. There was no postoperative facial nerve damage, temporalis muscle wasting, or symptoms of paresthesias around the incision line. Two patients developed a postoperative stroke manifested as symptoms of unilateral arm and facial weakness, receptive aphasia, and dysarthria.Conclusion:The MPT provides a reliable and less invasive alternative to the standard pterional craniotomy. Furthermore, ruptured and unruptured anterior circulation aneurysms can safely and effectively be treated with limited bone removal which provides better cosmetic outcomes and excellent postoperative temporalis muscle function.

Esthetics outcomes in patients submitted to pterional craniotomy and its variants: A scoping review

“…38 studies were found eligible for the established criteria (27 retrospective cohort studies, one outcome research, four prospective cohorts, one case–control, and five clinical trials). [ 1 , 5 - 8 , 10 , 11 , 13 , 17 , 18 , 20 , 21 , 23 - 25 , 28 - 31 , 33 , 34 , 36 - 38 , 41 , 44 , 45 , 48 ] 118 duplicates were found. 1328 papers were excluded as determined by the exclusion criteria [ Figure 1 ].…”

“…Pterional craniotomy (PC) is a classic approach for all anterior circulation aneurysms, suprasellar tumors (i.e., pituitary adenomas and craniopharyngiomas), and neurosurgeries where the opening of the Sylvian fissure is a crucial step. [ 1 ] Described for the 1 st time by Yasargil et al ., PC continues to be one of the most used nowadays. [ 2 , 46 ] PC has several variants such as the orbitozygomatic (OZ) approach, first proposed by Hakuba et al .…”

Minipterional craniotomy for surgical clipping of anterior circulation aneurysms: compatibility between the feasibility, safety and efficiency

“…Although there are studies that exclude ACoA aneurysms located in deep positions because they believe MPT to be unsuitable for these cases, 2) 6) we considered that MPT would need to be applicable even to ACoA aneurysms, which are known to be highly prevalent and to rupture even at small sizes. Therefore, we were able to successfully obliterate 154 cases with various directions, sizes, and locations.…”

“…Several reports with MPT for anterior circulation aneurysms included relatively small volume less than 50 cases, 8) 22) 25) 27) and we think that the evaluation of clinical and functional results maybe not fully investigated. 2) 6) 11) 16) By the way, Rychen et al reported a systemic review of the literatures on minimally invasive alternative approaches to CPT, 21) and they collectively reviewed approach-related complications in a total of 22 MPT articles. Postoperative hematoma and infarction occurred in 2.2% and 3.1% of all patients, and wound infection and CSF leak was reported in 1.2% and 0.3%.…”

“… 10) 13) 18) 20) 24) 25) Among them, CPT-modified minipterional craniotomy (MPT) has been introduced since the early 2010s as an alternative less invasive technique that decreased the length of skin incision, damage of temporal muscle, and craniotomy size. 2) 6) 8) 9) 11) 15 –17) 22) 27) However, some studies did not mention whether the clinical results of CPT were maintained in MPT, 2) 8) 25) and did not sufficiently verify the evaluation of functional efficiency by emphasizing only the lesser invasiveness. 6) 11) 16) Therefore, we performed a study to assess the feasibility, safety and efficiency of MPT for surgical clipping of unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms (RIA), with a special focus on the specific indication in the individual type of anterior circulation aneurysms.…”