The Clinical Analysis Of Microsurgery Through Lateral Supraorbital Approach For Ruptured Intracranial Aneurysms In Acute Phase

Objective By comparing the clinical data in medical records of patients who underwent mirosurgery through lateral supraorbital approach and pterional approach for ruptured intracranial aneurysms in acute phase in the Department of Neurosurgery,China-Japan Union Hospital,Jilin University ranging from March 2014 to September 2017.this paper was to summarize the key points and operation techniques of microsurgery through lateral supraorbital approach and to explore the safety and effectiveness of its application.Methods The clinical data of 85 patients with intracranial aneurysms who underwent microsurgery through lateral supraorbital approach(LSO)in the Department of Neurosurgery,China-Japan Union Hospital,Jilin University from March 2014 to September 2017,including age,gender,preoperative Hunt-Hess grade and modified CT-Fisher grade,anatomic characteristics of aneurysms,surgical incision length and operation time,whether there were intraoperative rupture and blood transfusion,the mean hospitalization time and postoperative GOS(Glasgow Outcome Scale)scores were collected and analyzed retrospectively.By comparing clinical data of 130 cases via pterional approach(PT)during this period,we analyzed the two groups statistically and combined with literature analysis to assess the clinical effect and safety of LSO approach and to provide a theoretical basis for further optimization of the surgical path of intracranial aneurysms.Results Two groups of patients with preoperative indicators such as age(group LSO: 52.1±8.5 years,group PT: 51.3±7.9 years;P=0.684),gender(group LSO: 34 men,51women;group PT: 48 men,72 women,P = 0.157),Hunt-Hess grade(group LSO: grade I 21 cases,grade II 39 cases,grade III 25 cases;group PT: grade I 28 cases,grade II 60 cases,grade III 42 cases;P=0.199)and modified CT-Fisher grade(group LSO: grade I 24 cases,grade II 48 cases,grade III 13 cases;group PT: grade I 35 cases,grade II 73 cases,grade III 22 cases;P=0.173),anatomic characteristics of aneurysms(such as position,shape,diameter)had no statistical difference,P > 0.05.The effect of preoperative indicators on the comparison of the two groups was basically excluded.there were statistical differences in surgical incision length(group LSO: 9.4±1.1cm,group PT: 15.2±1.2cm;P=0.002)and operation time(group LSO: 151.4±16.5min,group PT: 182.1±25.3min;P=0.017)between the two groups,P<0.05.the surgical incision length is related to the temporal muscle injury,postoperative infection and the beauty of incision healing,and the longer the operation time,the more severe the cerebral vasospasm(CVS)after operation would be.Within the two groups,intraoperative rupture(group LSO: 15 cases ruptured,70 cases unruptured;group PT: 21 cases ruptured,109 cases unruptured;P=0.317),intraoperative blood transfusion(group LSO: 6 cases with transfusion,79 cases without transfusion;group PT: 12 cases with transfusion,118 cases without transfusion;P=0.411)was not statistically significant,P>0.05.The surgical incision length and operation time in group LSO were shorter than those in group PT,but there were no differences between the two groups in the intraoperative rupture,intraoperative blood transfusion.Postoperative index comparison: The patient's mean hospitalization time(group LSO: 15.7±5.2d,group PT: 19.6±4.8d;P=0.034)in LSO group was shorter than that in PT group,P<0.05,and there was a statistical difference.GOS scores was used to evaluate the prognoses.4 points and 5 points were good prognoses,less than 4 points were considered as poor prognoses.The prognoses of the two groups(group LSO: 5 points 73 cases,4 points 6 cases,3 points 6 cases,PT group: 5 points 110 cases,4 points 12 cases,3 points 8 cases;P=0.286)were not statistically different,P>0.05.There were no differences in the overall prognoses of the two groups,but the mean hospitalization time in the LSO group was shorter than that in the PT group.Conclusion LSO approach is minimally invasive,relatively safe and could obtain a satisfactory surgical field exposure.LSO approach is suitable for the treatment of ruptured anterior circulation aneurysms.For patients of anterior circulation aneurysms with basilar artery bifurcation aneurysm,it is also applicable.Compared with PT approach,It has the advantages of smaller surgical trauma,shorter operation time,quicker recovery,less complications and shorter mean hospitalization time.So it can be used as a good alternative to PT approach and was suitable for popularization within microsurgery in acute phase for ruptured anterior circulation aneurysms of Hunt-Hess grade I ~ III and modified CT-Fisher grade I ~ III with basilar artery bifurcation aneurysms or not.