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Updated: Jun 7, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Enhanced Recovery After Surgery in clipping surgery for unruptured cerebral aneurysm: prospective nonrandomized
Objective:
As endovascular coiling has grown in popularity, clipping has evolved to reduce operative burden. Yet, improvements have largely focused on surgical techniques, with little emphasis on perioperative care. Enhanced Recovery After Surgery (ERAS) programs have improved outcomes across various surgical fields but remain inconsistently applied in neurosurgery. Given the lack of standardized, pathology-specific ERAS frameworks, this study evaluated whether implementing an ERAS protocol for elective aneurysm clipping could enhance recovery by improving pain control, reducing postoperative nausea and vomiting (PONV), and promoting overall recovery quality.
Methods:
This single-center, prospective, open-label study included adults undergoing elective clipping for unruptured intracranial aneurysms at Severance Hospital, Seoul. Consecutive patients were assigned to pre-ERAS (January 2023-February 2024) or ERAS (February-December 2024) cohorts. The ERAS protocol incorporated preoperative education, optimized fasting, local anesthesia, antiemetics, and early ambulation with nonopioid analgesia. Pain score, PONV incidence, and recovery quality survey (Quality of Recovery-40 [QoR-40]) results were compared between the groups using the Mann-Whitney U-test, Fisher's exact test, and multivariate regression to adjust confounders.
Results:
A total of 414 elective aneurysm-clipping procedures were analyzed (234 pre-ERAS, 180 ERAS). Baseline demographics and aneurysm characteristics were comparable between the groups. Postoperative pain scores were significantly lower in the ERAS group across postoperative days (PODs) 0-3 (all p < 0.001), and ERAS implementation was the only independent protective factor for pain. Opioid use decreased markedly, with earlier transition to oral nonopioid analgesics. The incidence of PONV was significantly lower from PODs 1 to 3, and ERAS remained an independent protective factor after multivariate adjustment. QoR-40 scores on POD 2 were higher in the ERAS group, indicating improved comfort and well-being, while hospital stay and complication rates were comparable.
Conclusions:
The ERAS protocol improved pain control, reduced PONV, and enhanced recovery in patients undergoing aneurysm clipping. These findings support the feasibility of ERAS in craniotomy surgery and highlight the potential for further optimization to improve outcomes.
