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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Comparison of Minimally Invasive and Pterional Craniotomies for Ruptured Anterior Circulation Aneurysms: A Propensity
Raywat Noiphithak1, Vich Yindeedej1, Warot Ratanavinitkul1
1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Background:
Minimally invasive craniotomy (MIC) for ruptured aneurysm remains a debatable issue because of unclear information regarding its safety and efficacy compared with standard approaches. Here, we compared the outcomes between MIC and pterional craniotomy (PTC) for the treatment of ruptured anterior circulation aneurysms.
Methods:
A database of patients with ruptured anterior circulation aneurysm who were treated with surgical clipping was reviewed. With the use of propensity score matching to balance the baseline characteristics of MIC and PTC groups, outcomes of the 2 groups were compared. Clinical predictors of favorable outcomes (modified Rankin scale score 0-2) were evaluated by using uni- and multivariate analyses.
Results:
A total of 102 matched pairs were identified. MIC resulted in a significantly shorter operative time (2.8 ± 0.9 vs. 4.2 ± 0.7 hours; P = 0.004) and hospital stay (14.2 ± 5.9 vs. 19.2 ± 9.1 days; P < 0.001), respectively. Both MIC and PTC had similar mortality and complication rates except for the incidences of intracranial hemorrhage (2% vs. 9.8%; P = 0.039) and brain injury (9.8% vs. 27.5%; P = 0.036), respectively. Use of MIC instead of standard surgery and lower World Federation of Neurosurgical Societies (WFNS) grade and absence of hydrocephalus were significant predictors of favorable outcome at 1 month, whereas higher WFNS grade and higher Fisher grade were significantly associated with a poor outcome at 6 months.
Conclusions:
For the treatment of ruptured anterior circulation aneurysms, MIC was comparable with PTC and presented additional advantage in terms of earlier recovery. Therefore, MIC can be considered an alternative surgical treatment in this setting.
Insights
Minimally invasive craniotomy (MIC) offers comparable outcomes to pterional craniotomy (PTC) for ruptured aneurysms, with faster recovery. This suggests MIC is a viable alternative surgical treatment for improved patient outcomes.
Area of Science:
- Neurosurgery
- Surgical Neurology
- Cerebrovascular Surgery
Background:
- Minimally invasive craniotomy (MIC) for ruptured aneurysms is debated due to limited safety and efficacy data compared to standard pterional craniotomy (PTC).
- This study aims to compare outcomes between MIC and PTC in treating ruptured anterior circulation aneurysms.
Purpose of the Study:
- To compare the safety and efficacy of minimally invasive craniotomy (MIC) versus pterional craniotomy (PTC) for ruptured anterior circulation aneurysms.
- To identify predictors of favorable and unfavorable outcomes following surgical treatment of ruptured aneurysms.
Main Methods:
- A retrospective review of patients with ruptured anterior circulation aneurysms treated with surgical clipping.
- Propensity score matching was used to balance baseline characteristics between MIC and PTC groups.
- Clinical predictors of favorable outcomes (modified Rankin Scale score 0-2) were assessed using univariate and multivariate analyses.
Main Results:
- 102 matched pairs (MIC vs. PTC) were identified.
- MIC demonstrated significantly shorter operative times (2.8 vs. 4.2 hours) and hospital stays (14.2 vs. 19.2 days) compared to PTC.
- While mortality and overall complication rates were similar, MIC showed lower incidences of intracranial hemorrhage (2% vs. 9.8%) and brain injury (9.8% vs. 27.5%).
Conclusions:
- Minimally invasive craniotomy (MIC) is comparable to pterional craniotomy (PTC) for treating ruptured anterior circulation aneurysms.
- MIC offers an advantage in terms of earlier patient recovery.
- MIC can be considered a safe and effective alternative surgical treatment for ruptured anterior circulation aneurysms.
