Comparison Between Lateral Supraorbital Approach And Pterional Approach To Clip Ruptured Anterior Communicating Artery Aneurysm

Background: Intracranial aneurysm which may cause sudden stroke represents one of the most lifethreatening disease,leading to high rate of morbidity and mortality.we compared lateral supraorbital approach with pterional approach to determine the most effective routine to clip low-grade anterior communicating artery aneurysm.Methods: A total of 85 patients with anterior communicating artery aneurysm underwent surgical clipping,34 through the lateral supraorbital approach and 51 through the pterional approach from June 2016 to June 2018 in the department of neurosurgery,Jinhua central hospital.We retrospectively analyzed the demographic and clinical variables including age,sex and Hunt-Hess grade.Accordingly,operative data,clinical outcome and postoperative complications were analyzed.The MRS at discharge and 6 months later were evaluated.Univariate and multivariate regression analysis was performed on a variety of factors including surgical approaches.Results: The 2 groups were comparable with respect to the incidence of operative aneurysm rupture(P>0.05).Compared with the pterional approach,the supraorbital approach could significantly reduce the size of the bone flap(12.9±2.8cm2 vs 27.1±4.3cm2),volume of operative bleeding(172±26ml vs 263±29ml)and the mean operation time(151±31min vs 166±26min),showing a statistical difference(P<0.05).Furthermore,the rate of procedural complications including postoperative epidural hematoma,hydrocephalus and cerebral infarction is similar(P>0.05),but the incidence of intracranial infection(6% vs 21%)was reduced by lateral supraorbital approach(P<0.05).Despite the significant difference in procedural complications,the length of stay and favorable outcomes in the long term were comparable within a 6-month follow-up(P>0.05).Age,Hunt-Hess classification,underlying disease,smoking and drinking were all risk factors for poor prognosis in the attribution analysis,and the surgical method of the supraorbital approach was considered to be an independent favorable factor after excluding confounding factors(P <0.05).Conclusion: According to our results,we recommend the LSO approach for ACo AA surgery for neurosurgeons who have gained sufficient experience with this technique due to its advantages over the pterional approach.