Minimally invasive surgery of the anterior circulation cerebral aneurysms

Abstract

Cilj: Usporediti skupine ispitanika liječenih jednim od dvaju kirurških postupaka u liječenju aneurizmi prednje cerebralne cirkulacije, pterionalnim pristupom ili supraorbitalnim keyhole pristupom, na temelju istraživanih pokazatelja i, na temelju te usporedbe, donijeti zaključke o mogućoj povezanosti istraživanih pokazatelja i potencijalnim prednostima i nedostatcima jednog u odnosu na drugi proučavani kirurški postupak. Nacrt studije: Povijesna kohortna studija. Ispitanici i metode: U istraživanje je uključeno 116 ispitanika s radiološki potvrđenom aneurizmom prednje cerebralne cirkulacije koji su liječeni jednim od dvaju navedenih kirurških pristupa u razdoblju od 2006. do 2015. godine. Svi podatci o istraživanim pokazateljima ispitanika (dob, spol, GCS, WFNS, HH, FISHER, lokalizacija aneurizme, popratne bolesti u anamnezi, prisutnost rupture i vrijeme proteklo od rupture do prijema, vrijeme operacije, komplikacije operacije i poslijeoperacijskog liječenja, GOS) preuzeti su iz medicinskih zapisa i statistički su obrađeni. Rezultati: Značajna razlika između ispitivanih skupina utvrđena je u raspodjeli ispitanika koji su imali aneurizmu ACoA (χ2 test, p = 0,039). Značajna razlika utvrđena je u raspodjeli ispitanika s obzirom na GOS i HH nakon što su podijeljeni u dvije skupine, ovisno o rasponu vrijednosti HH (χ2 test, p = 0,021). U raspodjeli ispitanika s obzirom na ostale istraživane pokazatelje između ispitivanih skupina nije utvrđena značajna razlika. Zaključak: Pterionalni pristup i supraorbitalni keyhole pristup ravnopravne su metode u kirurškom liječenju aneurizmi prednje cerebralne cirkulacije te se odluka o odabiru pristupu koji će se primijeniti treba temeljiti na individualnoj procjeni i preferenciji operatera. Krajnji ishod liječenja ne ovisi o primijenjenom kirurškom pristupu nego o kliničkom stanju pacijenta pri prijemu.Objectives: To compare two groups of participants treated by one of two surgical procedures of anterior cerebral circulation aneurysm treatment, pterional approach or supraorbital keyhole approach, according to considered parameters and, based on that comparison, bring conclusions on whether any of the parameters are related to other and on possible advantages and disadvantages of one approach compared to the other. Study design: Retrospective cohort study. Participants and methods: The study included 116 participants that had an anterior circulation cerebral aneurysm identified by radiological examination and were submitted to one of the two mentioned surgical approaches between 2006 and 2015 at the Clinic of Neurosurgery at Clinical Hospital Center Osijek. All data regarding the considered parameters (age, gender, GCS score, WFNS score, Hunt and Hess score, Fisher score, aneurysm localization, concomitant diseases, presence of rupture and elapsed time between the rupture and hospital reception, surgery timing, procedural or postoperative care complications, GOS score) were obtained from participants' medical records and statistically analyzed. Results: Significant difference between the defined groups was found in aneurysm localization distribution regarding the participants with anterior communicating artery (ACOM) aneurysm (χ2 test, p = 0,039). Furthermore, significant difference in the distribution of GOS score and Hunt and Hess score was found when the participants who were divided into two groups, according to the range which their Hunt and Hess score could fit into (χ2 test, p = 0,021). Statistically significant difference between the defined groups in the distribution of any other considered parameter was not found. Conclusion: Pterional approach and supraorbital keyhole approach are equally successful in treating anterior circulation cerebral aneurysms and the decision on which approach should be applied, should be made based on the individual assessment and surgeon's preferences. The final outcome of the treatment does not depend on the applied surgical approach but it depends on patient's Hunt and Hess score at the reception