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A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms
Pravinna, Genesan; Mohammad Saffari, Mohammad Haspani & Saiful Razman, Mohd Noor
Abstract
Background: Many different conventional approaches such as the frontal and pterional
approaches are used to access anterior circulation aneurysms. Recently, the supraorbital approach
has been widely applied to the treatment of anterior circulation aneurysms. This study was done to
evaluate which approach (pterional or supraorbital) has better outcomes in terms of residual neck
post-clipping, cosmetic satisfaction, scar tenderness, complications and functional outcomes.
Methodology: A total of 123 patients were recruited into this study, comprising 82 patients
who underwent a pterional approach and 41 patients who underwent a supraorbital approach.
Computed tomography angiograms, the modified Rankin Scale, and the visual analogue scale were
administered at 6 months to look for residual aneurysm, functional outcomes, scar tenderness,
and cosmetic satisfaction. Complication data were collected from patients’ case notes.
Results: The mean operating time for the pterional group was 226 min, compared to
supraorbital group, which was 192 min (P = 0.07). Cosmetic satisfaction was significantly higher
(P = 0.001) in the supraorbital group. There was no significant difference between the supraorbital
and pterional groups’ scar tenderness (P = 0.719), residual aneurysm (P = 0.719), or functional
outcomes (P = 0.137), and there was no significant difference between the groups in terms of intraoperative
and post-operative complications.
Conclusions: The supraorbital group had better cosmetic outcomes and shorter operating
times compared to the pterional group.
Keywords
supraorbital; craniotomy; aneurysm; neurosurgery; clipping
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