Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms

Abstract

Objective: The lateral supraorbital (LSO) approach is a modified method of the classic pterional approach and it has advantages of short skin incision and small craniotomy compared with the pterional approach. This study was designed to compare the two approaches in the surgical treatment of unruptured intracranial aneurysms.

Methods: We retrospectively reviewed 122 patients with 137 unruptured intracranial aneurysms treated by clipping, from July 2009 to April 2011. Between August 2010 and April 2011, 61 patients were treated by clipping via the lateral supraorbital approach and the same number of patients treated by clipping via the pterional approach were retrospectively enrolled. We analyzed the two groups and compared demographic, radiologic and clinical variables.

Results: The mean age of patients in the two groups was 54.6 years (LSO group) and 55.7 years (Pterion group). The mean duration of hospitalization was shorter in the LSO group than in the Pterion group (7.9 days vs. 9.0 days, p=0.125) and the mean operation time was also significantly shorter in the LSO group (117.1 minutes vs. 164.3 minutes, p<0.001). Furthermore, the mean craniotomy area was much smaller in the LSO group (1275.4 mm(2) vs. 2858.9 mm(2), p<0.001). The two groups showed similar distributions of aneurysm location and postoperative complications.

Conclusion: The lateral supraorbital approach for the clipping of unruptured intracranial aneurysm could be a good alternative to the classic pterional approach.

Keywords: Aneurysm; Clipping; Pterional approach; Supraorbital approach.

Fig. 1

The skin incision is usually behind the hair line and did not even go down in front of the ear to the level of zygomatic arch (A). The one layer skin-galea-muscle flap is dislocated after detachment from the bone by periosteal elevator and diathermy, and the flap is retracted anteriorly with spring hooks (B). Only one burr hole is made posteriorly and the bone flap is detached mainly by side-cutting craniotome with the basal part drilled off before lifting the flap (C). The bone flap size is about 3×4 cm (D). The dura mater is opened in a curvilinear incision pointing anterolaterally and elevated with stitches (E). After aneurysm clipping, the bone flap is secured using one skull fixator and two plate and screw systems (F).