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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

Abstract

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.

Keywords

AComAn Rupture Pterional Supraorbital 

Notes

Funding

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.

References

  1. 1.
    Beseoglu K, Lodes S, Stummer W, Steiger HJ, Hanggi D (2011) The transorbital keyhole approach: early and long-term outcome analysis of approach-related morbidity and cosmetic results. Technical note. J Neurosurg 114:852–856.  https://doi.org/10.3171/2010.9.jns1095 CrossRefPubMedGoogle Scholar
  2. 2.
    Bhatoe HS (2009) Transciliary supraorbital keyhole approach in the management of aneurysms of anterior circulation: operative nuances. Neurol India 57:599–606.  https://doi.org/10.4103/0028-3886.57812 CrossRefPubMedGoogle Scholar
  3. 3.
    Cha KC, Hong SC, Kim JS (2012) Comparison between lateral supraorbital approach and pterional approach in the surgical treatment of unruptured intracranial aneurysms. J Korean Neurosurg S 51:334–337.  https://doi.org/10.3340/jkns.2012.51.6.334 CrossRefGoogle Scholar
  4. 4.
    Chalouhi N, Jabbour P, Ibrahim I, Starke RM, Younes P, El Hage G, Samaha E (2013) Surgical treatment of ruptured anterior circulation aneurysms: comparison of pterional and supraorbital keyhole approaches. Neurosurgery 72:437–441; discussion 441-432.  https://doi.org/10.1227/NEU.0b013e3182804e9c CrossRefPubMedGoogle Scholar
  5. 5.
    Debrun GM, Aletich VA, Thornton J, Alazzaz A, Charbel FT, Ausman JI, Bashir Q (2000) Techniques of coiling cerebral aneurysms. Surg Neurol 53:150–156CrossRefGoogle Scholar
  6. 6.
    Deng X, Gao F, Zhang D, Zhang Y, Wang R, Wang S, Cao Y, Zhao Y, Pan Y, Liu X, Zhang Q, Zhao J (2018) Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score-matched analysis. J Neurosurg 128:1785–1791.  https://doi.org/10.3171/2017.2.jns162405 CrossRefPubMedGoogle Scholar
  7. 7.
    Dzhindzhikhadze RS, Dreval ON, Lazarev VA, Kambiev RL (2016) Supraorbital keyhole craniotomy in surgery of anterior circle of Willis aneurysms. Zh Vopr Neirokhir Im N N Burdenko 80:78–84.  https://doi.org/10.17116/neiro201680578-84 CrossRefPubMedGoogle Scholar
  8. 8.
    Fischer G, Stadie A, Reisch R, Hopf NJ, Fries G, Bocher-Schwarz H, van Lindert E, Ungersbock K, Knosp E, Oertel J, Perneczky A (2011) The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery 68:45–51; discussion 51.  https://doi.org/10.1227/NEU.0b013e31820934ca CrossRefPubMedGoogle Scholar
  9. 9.
    Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB (1982) The supraorbital approach: technical note. Neurosurgery 11:537–542PubMedGoogle Scholar
  10. 10.
    Kim Y, Yoo CJ, Park CW, Kim MJ, Choi DH, Kim YJ, Park K (2016) Modified supraorbital keyhole approach to anterior circulation aneurysms. J Cerebrovasc Endovasc Neurosurg 18:5–11.  https://doi.org/10.7461/jcen.2016.18.1.5 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lan Q, Zhang H, Zhu Q, Chen A, Chen Y, Xu L, Wang Z, Yuan L, Liu S (2017) Keyhole approach for clipping intracranial aneurysm: comparison of supraorbital and pterional keyhole approach. World Neurosurg 102:350–359.  https://doi.org/10.1016/j.wneu.2017.02.025 CrossRefPubMedGoogle Scholar
  12. 12.
    Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB (2012) Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg 4:182–189.  https://doi.org/10.1136/jnis.2011.004978 CrossRefPubMedGoogle Scholar
  13. 13.
    McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC (2012) The Barrow Ruptured Aneurysm Trial. J Neurosurg 116:135–144.  https://doi.org/10.3171/2011.8.JNS101767 CrossRefPubMedGoogle Scholar
  14. 14.
    Mizunari T, Murai Y, Kobayashi S, Hoshino S, Teramoto A (2011) Utility of the orbitocranial approach for clipping of anterior communicating artery aneurysms: significance of dissection of the interhemispheric fissure and the Sylvian fissure. J Nippon Med Sch 78:77–83CrossRefGoogle Scholar
  15. 15.
    Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet (London, England) 360:1267–1274CrossRefGoogle Scholar
  16. 16.
    Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet (London, England) 366:809–817.  https://doi.org/10.1016/s0140-6736(05)67214-5 CrossRefGoogle Scholar
  17. 17.
    Mori K, Yamamoto T, Nakao Y, Oyama K, Esaki T, Watanabe M, Nonaka S, Hara T, Honma K (2008) Lateral supraorbital keyhole approach to clip unruptured anterior communicating artery aneurysms. Minim Invasive Neurosurg 51:292–297.  https://doi.org/10.1055/s-0028-1085422 CrossRefPubMedGoogle Scholar
  18. 18.
    Ormond DR, Hadjipanayis CG (2013) The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg 2013:296469.  https://doi.org/10.1155/2013/296469 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57:242–255 discussion 242-255PubMedGoogle Scholar
  20. 20.
    Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, Partovi S, Nakaji P, Wallace RC (2015) The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg 123:609–617.  https://doi.org/10.3171/2014.9.JNS141749 CrossRefPubMedGoogle Scholar
  21. 21.
    Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscara C, Scotti M, Romito R, Mariani L, Mazzaferro V (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880.  https://doi.org/10.1002/bjs.10137 CrossRefPubMedGoogle Scholar
  22. 22.
    Stamates MM, Wong AK, Bhansali A, Wong RH (2017) Supraorbital keyhole craniotomy for basilar artery aneurysms: accounting for the “cliff” effect. Oper Neurosurg (Hagerstown) 13:182–187.  https://doi.org/10.1093/ons/opw040 CrossRefGoogle Scholar
  23. 23.
    Wang H, Luo L, Ye Z, Li W, Chen C, Ba Y, Ning X, Guo Y (2015) Clipping of anterior communicating artery aneurysms in the early post-rupture stage via transorbital keyhole approach--Chinese neurosurgical experience. Br J Neurosurg 29:644–649.  https://doi.org/10.3109/02688697.2015.1023774 CrossRefPubMedGoogle Scholar
  24. 24.
    Wong JH, Tymianski R, Radovanovic I, Tymianski M (2015) Minimally invasive microsurgery for cerebral aneurysms. Stroke 46:2699–2706.  https://doi.org/10.1161/strokeaha.115.008221 CrossRefPubMedGoogle Scholar
  25. 25.
    Zumofen DW, Rychen J, Roethlisberger M, Taub E, Kalbermatten D, Nossek E, Potts M, Guzman R, Riina HA, Mariani L (2017) A review of the literature on the transciliary supraorbital keyhole approach. World Neurosurg 98:614–624.  https://doi.org/10.1016/j.wneu.2016.10.110 CrossRefPubMedGoogle Scholar

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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