Experience Using the Pterional Keyhole Approach for the Treatment of Ruptured Intracranial Aneurysms of the Anterior Circulation.

Abstract

The pterional keyhole approach is a more recently introduced minimally invasive version of the traditional pterional approach for treating aneurysms of the anterior circulation. In this study, we compared operative parameters and clinical outcomes in patients treated with the pterional keyhole approach and historical controls in whom the traditional pterional approach was used. We reviewer records of 356 patients treated with the pterional keyhole approach between 2009 and 2016, along with those of 301 patients treated via the traditional pterional approach at the same period who served as a control group. The clinical manifestations, surgical details, postoperative complications, and modified Rankin Scale scores in the 2 groups were retrospectively compared. There were 408 aneurysms in the study group and 362 aneurysms in the control group. In the pterional keyhole group, the total clipping ratio was 93.6%, leaving a remnant/wrapping rate of 6.37%, compared with 93.9% and 6.08%, respectively, in the standard pterional group. In the patients treated via the keyhole approach, the mean bone flap diameter was 4 × 3 cm, mean blood loss was 204 ± 100 mL, mean operation time was 160 ± 57 minutes, and mean length of stay was 8.32 ± 2.72 days, compared with control group parameters of 5 × 6 cm, 284 ± 150 mL, 180 ± 49 minutes, and 11.32 ± 2.48 days, respectively. At a 6-month follow-up, 71.1% had a favorable outcome, 25.8% had a poor outcome, and the mortality was 3.09%, compared with 68.1%, 29.9% and 1.99%, respectively, in the control group. The pterional keyhole approach offers shorter operative times, less blood loss, shorter length of stay, and improved cosmesis without sacrificing outcomes compared with traditional pterional craniotomy.