Supraorbital keyhole versus pterional craniotomies for ruptured anterior communicating artery aneurysms: a propensity score–matched analysis

  • Le-Bao Yu
  • Zheng Huang
  • Ze-Guang Ren
  • Jun-Shi Shao
  • Yan Zhang
  • Rong Wang
  • Dong Zhang
Original Article


The safety and efficacy of the supraorbital keyhole approach for aneurysm surgery have not been well researched through a high-quality controlled study. The objective of the study was to compare the safety and efficacy of the supraorbital and pterional approaches for ruptured anterior communicating aneurysm (AComAn). A total of 140 patients, with 70 patients in each group, were enrolled after 1:1 propensity score matching. Clinical variables, postoperative complications, and long-term outcomes were retrospectively compared. Baseline characteristics were equivalent between the two groups. Significantly shorter operative time and less intraoperative blood loss were observed in the supraorbital group compared to the pterional group (141.9 min vs. 184.5 min, P < 0.001; 160.4 ml vs. 250.7 ml, P = 0.008). The incidence of intraoperative aneurysm rupture was similar between the groups (20% vs. 18.6%, P = 0.830). The rate of procedural complications involving subdural hematoma and intracranial infection was lower in patients treated through the supraorbital (10.0%) vs. the pterional approach (32.9%, P < 0.001), but no significant difference was observed for the incidence of ischemic events (15.7% vs. 18.6%, P = 0.654). Within a median 33.4-month (range, 11–67 months) follow-up, a similar proportion of patients achieved a favorable outcome (Glasgow Outcome Scale IV or V) across the two groups (83.6% vs. 80.0%, P = 0.285), while better cosmetic results were observed in the supraorbital group (94.0%) vs. the pterional group (86.2%, P = 0.129). According to our results, we recommend the keyhole approach for AComAn surgery for neurosurgeons who have gained sufficient experience with this technique due to its advantages over the pterional approach.


AComAn Rupture Pterional Supraorbital 



This work received financial support from the China National Clinical Research Center for Neurosurgical Diseases (NCRC-ND) (2015BAI12B04).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The current study was approved by the ethical committee of our hospital.

Informed consent

Informed consent was obtained for all enrolled patients.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
  2. 2.China National Clinical Research Center for Neurological Diseases (NCRC-ND)BeijingChina
  3. 3.Center of StrokeBeijing Institute for Brain DisordersBeijingChina
  4. 4.Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingChina
  5. 5.Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangsha ShiChina
  6. 6.Department of NeurosurgeryUniversity of Rochester Medical CenterRochesterUSA

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