Clinical Comparison Of Supraorbital Lateral Approach And Pterional Approach In The Treatment Of Acute Anterior Communicating Aneurysm Rupture

Objective:To study the clinical effect of two surgical approaches,supraorbital lateral approach and pterional approach,in the treatment of acute anterior communicating aneurysm rupture.Methods:From September 2017 to May 2019,86 patients with acute anterior communicating artery aneurysm rupture were included in the study.All patients met the indications of surgical treatment.47 patients were treated by pterional approach as control group.The other 39 patients were treated by supraorbital lateral approach.After operation,CT angiography(CTA)was performed in the two groups,and the closure of anterior communicating artery aneurysm was observed to evaluate the therapeutic effect.The operation time,intraoperative hemorrhage,incision length,bone flap size and hospitalization time were observed.Glasgow Outcome Scale(GOS)was used to assess the neurological function of patients,The quality of life of patients was assessed by SF-36.The postoperative complications of the two groups were observed.Results:After treatment,CTA examination of both groups showed that aneurysms were completely occluded by the parent artery.Further research found that:Operation time(176.72±43.16)min,hospitalization time(15.13±5.31)d,blood loss(92.05±29.39)ml,incision length(9.94± 1.69)cm,bone flap size(13.73±2.99)cm2,hospitalization cost(61826.87±8983.96)yuan,bone flap removal rate 0%better than the control patients(219.43±58.94)min,hospitalization time(17.00±5.88)d,blood loss(242.23±62.06)ml,incision length(16.68±2.70)cm,bone flap size(46.81 ±25.95)cm2,hospital expenses(67041.00±9225.69)yuan,bone flap removal rate 23%,the differences were statistically significant(P<0.05).At discharge,the GOS score of the observation group was(3.92±0.63).The GOS score of the control group was(2.78±0.47).The GOS score of the observation group was higher than that of the control group(P<0.05).There was no statistically significant difference in PF,RP,BP,GH,VT,SF,RE and MH scores between the two groups before surgery(P>0.05).The scores of PF,RP,BP,GH,VT,SF,RE and MH in the observation group were significantly higher than those in the control group(P<0.05).Two groups of patients with postoperative complications including intracranial hematoma,hydrocephalus,intracranial infection,epilepsy and cerebrospinal fluid leakage,facial nerve injury,cerebral vasospasm,cerebral infarction and poor healing of incision,There were 8 complications in 39 cases in the observation group and 14 in 47 cases in the control group.The number of complications in the observation group was significantly less than that in the control group,which was statistically significant(P<0.05).Conclusion:The superior lateral orbital approach is effective in the treatment of anterior communicating aneurysm rupture,The operation is simple and easy,less trauma,Significant improvement of the prognosis and the life treatment of patients.Compared with pterional approach,the complications of supraorbital lateral approach in the treatment of acute anterior communicating aneurysm are less,and both safety and minimally invasive are considered.