The Pterional and Suprabrow Approaches for Aneurysm Surgery - a Systematic Review of Intraoperative

Available online 28 February 2013
Publication year: 2013
Source:World Neurosurgery

Objective To assess the safety of the suprabrow approach (SBCA) for aneurysm surgery by comparing intraoperative rupture rates with those for the standard pterional approach. Methods A systematic review of all literature published in or after 1997 was performed using specified search words. All papers that described aneurysm surgery by one of two approaches-pterional or suprabrow, and mentioned the rate of intraop rupture were included. A total of 41 papers were found fit for inclusion for the final analysis. Papers that focused on giant, bilateral, posterior fossa or previously coiled aneurysms were not included. The Chi square test was used to compare the two cohorts and various subgroup analyses were carried out. A p value of <0.05 was considered as being significant. Results The search of literature yielded a total of 9488 aneurysms (41 papers), 7535 operated via pterional and 1953 aneurysms via SBCA. The overall IOR rate for the entire group was 9.20%. In the PtCA group, the rate of IOR was 10.09% and in the SBCA group IOR occurred in 5.78%. The IOR rate in the PtCA group was almost double that in the SBCA group and the odds ratio for this difference was 1.8 (95% CI 1.49-2.26), p<0.001. 3039 ruptured aneurysms were analyzed, 2848 aneurysms in the PtCA group and 191 in the SBCA group. The rate of IOR was 14.15% for the overall group, 13.8% in the PtCA group and 19.37% in the SBCA group. The difference in IOR between the PtCA group and SBCA group for ruptured aneurysms was found to be significant (OR 1.5, 95% CI 1.003-2.119, p<0.05). The number of unruptured aneurysms in the PtCA group was 862 (39.4%) and in the SBCA group was 232 (49.1%). The difference in the number of unruptured aneurysms between the groups was significant (p<0.001). The rate of IOR was significantly less via SBCA than the pterional approach. Conclusions The rate of intraop rupture is significantly higher when ruptured aneurysms are operated via the SBCA (in comparison to the pterional approach). However, the SBCA may be safer for unruptured and MCA aneurysms with a lower rate of IOR.

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Júlio Leonardo B. Pereira

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