Supraorbital Eyebrow Approach and Pterional Approach in Surgical Treatment of Ruptured and Unruptured Aneurysms: A Propensity Score Matched Analysis

Abstract

Introduction To determine safety and efficacy of the supraorbital eyebrow approach (SEA) in clipping of ruptured and unruptured aneurysms in comparison with the pterional approach (PA).Methods A total of 229 patients who underwent surgical clipping of aneurysm from 2013–2022 and met inclusion criteria were recruited in the study. Study group of 67 patients treated via the SEA and comparison group of 162 patients treated via the PA were formed. Then, study groups of 66 patients in each with equal incoming factors were analyzed using propensity score technique. Parameters of safety and efficacy were then retrospectively compared.Results Successful clipping was achieved in all cases of both groups. There were no patients in the SEA group who required conversion to the standard craniotomy. There were no procedure-related deaths in this series. No patient experienced early or late rebleeding in either group. Mean blood loss volume in the SEA group was lower than in the PA group by approximately 77.5ml (P < .001). There were favorable differences in the SEA group regarding postoperative neurological deficit (p = .016), postoperative epileptic seizures rate (p = .013) ischemic and hemorrhagic complications (p = .028 and .0009 respectively) and outcomes (p < .001). Patients’ satisfaction of cosmetic result measured by visual analogue scale were rated highly in both groups (p = .081).Conclusion For patients where SEA provides adequate exposure, the SEA provides safety and cosmetic outcomes that are not inferior to the PA.