Lateral Supraorbital Approach Applied To Anterior Circulation Aneurysms

Objective： To analyze the clinical practice of the microsurgical operation inintracranial ruptured aneurysms of anterior circulation via lateral supraorbital approach andpterional approach. Meanwhile, sum up the clinical results and the strengths and weaknessesof these approaches in order to improve on the aneurysms of the treatment.Methods: A retrospective analysis of82patients with intracranial ruptured aneurysmsof anterior circulation who were treated from June2011to December2011in the firstaffiliated hospital of Soochow University.8patients were excluded,38patients wereassigned to neurosurgical treatment via lateral supraorbital approach, while36ones weretreatment by pterional approach. The following clinical details were recorded: sex, age,Hunt-Hess of SAH before treatment, CT Fisher grade of SAH, the number and position ofaneurysms, operation time, length of incisions, amount of bleeding, the number ofaneurysm clipping, the number of patients of removing bone flap, hospital stay, GOS aftertwo months. Then, we compare these data. Data were analyzed using t, χ2, rank sum test.All patients were at Hunt-HessⅠ-Ⅲ.Results: The patients allocated LSO treatment were discharged. Two months later,33cases got recovery,5cases were light disability,0cases were severe disability and0case was at PVS. Average operation time was142±32min, average length of incision was9.2±1.5cm, the number of ruptured aneurysms is5in the operation and The mean hospitalstay was11.9±4.3days. While,30patients were excellent after two months,3cases weremoderately disability,1case was severe disability and2cases were at PVS. Averageoperation time was180±40min, average length of incision was16.3±3.4cm, the numberof ruptured aneurysms is6in the operation and The mean hospital stay was14.4±5.4days. There is no significant difference in good recovery rate after operation, but there issignificant difference in operation time, length of incisions, volume of bleed in operationand the mean hospital stay.Conclusions：In patients with a ruptured intracranial aneurysm of anterior circulation,endovascular treatment is rapid development which has been widely used,but it requireshigh technology and higher treatment costs. Also, it is difficult to carry out in primaryhospital. Therefore, surgical operation treatment is still the main treatment of aneurysms.However, compared to LSO the classical or modified pterional approach is not conduciveto the patients with aesthetic demand which bring more trauma and bleeding. We foundthat the two approaches for postoperative recovery of patients are no significant difference.Nevertheless, less disutility and better effect can be gained by LSO. This study indicatesLSO is a relatively micro-invasive neurosurgery. Although the effect of this approach isremarkable, the long-term efficacy of LSO remains open.