Pterional versus superciliary keyhole approach: direct comparison of approach-related complaints and satisfaction in the same patient

Abstract

OBJECTIVE The objective of this study was to evaluate and compare the level of patient satisfaction and approach-related patient complaints between a superciliary keyhole approach and a pterional approach. METHODS Patients who underwent an ipsilateral superciliary keyhole approach and a contralateral pterional approach for bilateral intracranial aneurysms during an 11-year period were contacted and asked to complete a patient satisfaction questionnaire. The questionnaire covered 5 complaint areas related to the surgical approaches: craniotomy-related pain, sensory symptoms in the head, cosmetic complaints, palpable cranial irregularities, and limited mouth opening. The patients were asked to rate the 5 complaint areas on a scale from 0 (asymptomatic or very pleasant) to 4 (severely symptomatic or very unpleasant). Finally, the patients were asked to rate the level of overall satisfaction related to each surgical procedure on a visual analog scale (VAS) from 0 (most unsatisfactory) to 100 (most satisfactory). RESULTS A total of 21 patients completed the patient satisfaction questionnaire during a follow-up clinic visit. For the superciliary procedures, no craniotomy-related pain, palpable irregularities, or limited mouth opening was reported, and only minor sensory symptoms (numbness in the forehead) and cosmetic complaints (short linear operative scar) were reported (score = 1) by 1 (4.8%) and 3 patients (14.3%), respectively. Compared with the pterional approach, the superciliary approach showed better outcomes regarding the incidence of craniotomy-related pain, cosmetic complaints, and palpable irregularities, with a significant between-approach difference (p < 0.05). Furthermore, the VAS score for patient satisfaction was significantly higher for the superciliary approach (mean 95.2 ± 6.0 [SD], range 80-100) than for the pterional approach (mean 71.4 ± 10.6, range 50-90). Moreover, for the pterional approach, a multiple linear regression analysis indicated that the crucial factors decreasing the level of patient satisfaction were cosmetic complaints, craniotomy-related pain, and sensory symptoms, in order of importance (p < 0.05). CONCLUSIONS In successful cases in which the primary surgical goal of complete aneurysm clipping without postoperative complications is achieved, a superciliary keyhole approach provides a much higher level of patient satisfaction than a pterional approach, despite a facial wound. For a pterional approach, the patient satisfaction level is affected by the cosmetic results, craniotomy-related pain, and numbness behind the hairline, in order of importance.

Safety, Feasibility, and Patient-Rated Outcome of Sonolucent Cranioplasty in Extracranial-Intracranial Bypass Surgery to Allow for Transcranioplasty Ultrasound Assessment

“…As shown in previous studies, cosmetic results matter to patients, especially in the frontotemporal region. 14 , 26 It has been shown that even a dent or irregularity of the cranioplasty may jeopardize the success of the surgery. 26 It was discovered that TCUS imaging may be painful within the first days after surgery, which is explained by the postoperative pain over the wound incision, and should be kept in mind when performed at bedside.…”

“…The questions were modified on the basis of a previous publication by Park et al. 14 In addition, patients who had a bypass surgery before were asked to comment on overall cosmetic result compared with the PMMA implant.…”

Supraorbital Keyhole Approach for Intracranial Aneurysms : Transitioning from Concerns to Confidence

“…Park et al 21) conducted a patient satisfaction survey on 21 patients who underwent an ipsilateral superciliary keyhole approach and contralateral pterional approach for bilateral intracranial aneurysms. When asked about the cosmetic results for the supraorbital approach vs. the pterional approach, 76.2% of the patients complained about the cosmetic results for the pterional approach side due to a loss of frontal hair along the operative scar, disfiguring scar, and anterior temporal hollow, whereas only 14.3% of the patients had minor cosmetic complaints for the supraorbital approach side due to the operative scar.…”

“…After achieving the surgical goal, the patient satisfaction level is affected by the invasiveness of the surgical approach. When patients who underwent both an ipsilateral supraorbital keyhole approach and a contralateral pterional approach for bilateral aneurysms were asked to compare their experience, their overall satisfaction level was significantly higher for the supraorbital keyhole approach 21) . As regards their ptrional experience, the complaint scores were higher for the cosmetic results, palpable cranial irregularities, and craniotomy-related pain at or around the bone flap.…”

“…Neurosurgical minimalism to reduce iatrogenic traumatization involves a variety of techniques intended to minimize the surgical wound, pain, complications, and hospital stay, along with avoiding neurological deficits 11,13,20,21,29) . Since the introduction of a concept of keyhole approach by Perneczky and colleagues 33) , a supraorbital keyhole approach is commonly applied for treating anterior circulation aneurysms and tumorous lesions in the parasellar and suprasellar regions 7,8,10,22,28,35) .…”