Lateral Supraorbital Approach In The Microsurgery Of Ruptured Anterior Circulation Aneurysms

Objective:By comparing the related items in the microsurgery of ruptured anterior circulation aneurysms between the two groups,this paper was to make a summary of the key points in the manipulation and operational techniques.And then we explored the application value of the lateral supraorbital approach in the microsurgery of this sort of aneurysms.Methods:This paper retrospectively reviewed 133 cases admitted to Qilu Hospital during the period of 1st June 2014 to 30th Sep 2016.They were divided into two groups named lateral supraorbital approach(LSOA)group and classical pterional approach(PA)group according to their specific surgical approach respectively.46 patients were in the LSOA group and 87 were in the other.We kept an account of every clinical index of the patients.The preoperative indexes included the gender,age,Hunt-Hess scale,CT-Fisher grade,as well as the anatomical characteristics of the aneurysms.The Hunt-Hess Scale and CT-Fisher grade were used to evaluate their conditions briefly on their arrival.The intra-operative items such as timing and duration of the surgery,length of incisures,blood loss,and success rate were used to analyze the effects of the microsurgery.And as for the postoperative items,we used GOS scale to evaluate their prognosis on their discharge.And we made a judgment of the recovery speed via the hospitalization period.This paper collected the information about the aneurysms'anatomical characteristics from the image date.And the other clinical items were collected from the medical records.We statistically analyzed every item afterwards.With this method,this paper then analyzed the items of cases received operations in the early and middle phase in the two groups.Results:There were no statistically difference in the age(P=0.382)or gender proportion(18/28 versus 34/53,P=0.996).And their Hunt-Hess scales(12/25/9 versus 22/47/18,P=0.987)and CT-Fisher scales(5/24/17 versus 9/51/27,P=0.746)were similar.No statistical significances existed in the differences of their aneurysms'anatomical characteristics(P>0.05).The influence of the preoperative factors to the surgery was basically ruled out by this analysis result.With regard to the intra-operative factors,it took less time for a surgeon to finish their operation(183±40 min versus 217±63 min,P<0.05)via LSOA.Apart from it,LSOA group had smaller bone flaps,shorter incisures than the PA group(P<0.05).But no significant difference was found in the other items such as side of craniotomy(20/26 versus 41/46,P=0.688),ratio of aneurysms ruptured(4/42 versus 9/78),rates of blood transfusion(6/40 versus 24/63)or the success rates of aneurysms clipped(100%versus 100%).As for the postoperative factors,cases in the LSOA group have shorter length of stay after the surgery(10.5±4.8 days versus 16.2± 11.8 days,P<0.05),which was a symbol of quicker recovery.We divided the patients into 3 subgroups according to their GOS grade,which are GR(good recovery),MD(moderate disability),SD(severe disability).No difference was found in the prognosis between the two group(43/2/1 versus 75/9/3,P=0.528).Cases received operations within 7 days in the LSOA group had significantly a shorter incision,a smaller bone flap,shorter operation time length and shorter length of stay(P<0.05).And other items among them are similar(P?0.05).This result was similar to the analysis result of the whole data.Conclusion:1 The lateral supraorbital approach is an ideal choice for the microsurgery of ruptured anterior circulation aneurysms.With a high efficiency and a high level of safety,it is also appropriate for the early and middle phase operation of this sort of aneurysms.2 Compared with the classical pterional approach,the lateral supraorbital approach has the advantage of shorter incisures,smaller bone flap size,shorter surgical duration,less blood loss in the operation.And its effects are similar to the classical pterional approach.It also meets the requirement of the so-called micro-invasive concept,and it is beneficial for the patients' quicker recovery.Besides,it has a relatively brief anatomical structure and a simple manipulation associated with craniotomy,so it is suitable for the younger surgeon to study.3 A good command of the anatomical knowledge and a meticulous operation is the key for the surgeon to reduce the incidence of craniotomy related complications.