Clinical Comparative Analysis Of Lateral Supraorbital Approach And Traditional Pterional Approach In The Treatment Of Intracranial Anterior Circulation Aneurysms

Objective: The purpose of the research is to provide a reference for the selection of surgical methods in clinical work by comparison and analysis of the related data of two surgical approaches,lateral supraorbital approach and pterional approach,in the treatment of ruptured intracranial anterior circulation aneurysms.Methods: 73 patients with ruptured intracranial anterior circulation aneurysms in our hospital were selected as the research object.They were divided into two groups on the basis of different surgical methods: group A(35 cases)underwent microsurgery via lateral supraorbital approach,and group B(38 cases)via pterional approach.The data including sex,age,preoperative complications,Hunt-Hess grade and modified Fisher grade,site of aneurysm,length of incision,intraoperative hemorrhage,time of operation,bone window area,postoperative complications and hospitalization time,and GOS score of postoperative 3 months were reviewed.Finally,the results were analyzed and tested by statistical software to compare between the two groups.Results: There was no significant difference in sex,age and preoperative complications between the two groups(P > 0.05).On the basis of Hunt-Hess grade classification,32 patients in group A were at grade I-II,and the other 3 at grade III,28 patients in group B were at grade I-II and the other 10 at grade III.On the basis of modified Fisher grade classification,28 patients in group A were at grade I-II,and the other 7 at grade III,29 patients in group B were at grade I-II and the other 9 at grade III.There was also no significant difference in Hunt-Hess grade and complications between the two groups(P > 0.05).Compared with group B,group A had shorter incision length,fewer intraoperative hemorrhage,shorter operation time and hospitalization time after operation,and smaller bone window area(P < 0.05).There was no significant difference in the incidence of intraoperative aneurysm rupture between group A and group B(P > 0.05).The incidence of superficial temporal artery injury,cerebrospinal fluid leakage and temporal muscle atrophy in group A were significantly lower than those in group B(P < 0.05).There was no significant difference in GOS score of postoperative 3 months between the two groups(P > 0.05).The mortality and patient in vegetative state rate were 0 in 3 months after operation.Conclusion:(1)Compared with pterional approach,lateral supraorbital approach has better clinical effect in the treatment of intracranial anterior circulation aneurysms.The length of surgical incision is significantly shorter,the amount of intraoperative hemorrhage is significantly lower,the operation time and postoperative hospitalization time are significantly shorter,the area of bone window is significantly smaller,which is more in line with the concept of "minimally invasive".(2)Compared with pterional approach,the lateral supraorbital approach has fewer complications,quicker recovery,and which is suitable for popularization.(3)In the clinical treatment of ruptured intracranial anterior circulation aneurysms,the microsurgery via lateral supraorbital approach is efficient,safe and conducive to the rehabilitation of patients.It is a reasonable choice for the treatment of ruptured intracranial anterior circulation aneurysms.