Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA.
World Neurosurg. 2013 Dec;80(6):836-44. doi: 10.1016/j.wneu.2013.02.072. Epub 2013 Feb 28.
To assess the safety of the suprabrow approach (SBCA) for aneurysm surgery by comparing intraoperative rupture rates with those for the standard pterional approach.
A systematic review of all literature published in or after 1997 was performed using specified search words. All articles described aneurysm surgery by one of two approaches--pterional or suprabrow--and mentioned the rate of intraoperative rupture. A total of 41 articles were found fit for inclusion for the final analysis. Articles that focused on giant, bilateral, posterior fossa, or previously coiled aneurysms were not included. The χ(2) test was used to compare the two cohorts and various subgroup analyses were carried out. A P value of <0.05 was considered significant.
The search of literature yielded 9488 aneurysm reports (41 articles), 7535 operated by the pterional approach and 1953 aneurysms by the SBCA. The overall intraoperative rupture (IOR) rate for the entire group was 9.20%. In the pterional craniotomy approach (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 (OR) for this difference was 1.8 (95% confidence interval [CI] 1.49-2.26; P< 0.001). A total of 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 the 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, it 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 with the SBCA than with the pterional approach.
The rate of intraoperative rupture is significantly higher when ruptured aneurysms are operated with the SBCA (in comparison to the pterional approach). However, the SBCA may be safer for unruptured and middle cerebral artery aneurysms with a lower rate of IOR.
通过比较标准翼点入路和额下入路手术中破裂率，评估额下入路（SBCA）治疗动脉瘤的安全性。
对 1997 年以后发表的所有文献进行了系统综述，使用了特定的搜索词。所有文章都描述了通过翼点或额下入路之一进行的动脉瘤手术，并提到了术中破裂率。共有 41 篇文章符合最终分析的要求。未包括专门针对巨大、双侧、后颅窝或先前已栓塞的动脉瘤的文章。采用卡方检验比较两组，并进行了各种亚组分析。P 值<0.05 被认为有统计学意义。
文献检索共获得 9488 例动脉瘤报告（41 篇文章），其中 7535 例采用翼点入路，1953 例采用 SBCA。整个研究组的术中破裂率（IOR）为 9.20%。在翼点开颅术（PtCA）组中，IOR 发生率为 10.09%，而 SBCA 组为 5.78%。PtCA 组的 IOR 发生率几乎是 SBCA 组的两倍，差异的优势比（OR）为 1.8（95%置信区间[CI]为 1.49-2.26；P<0.001）。对 3039 例破裂动脉瘤进行了分析，其中 2848 例在 PtCA 组，191 例在 SBCA 组。总体组的 IOR 发生率为 14.15%，PtCA 组为 13.8%，SBCA 组为 19.37%。PtCA 组和 SBCA 组破裂动脉瘤的 IOR 差异有统计学意义（OR 1.5，95%CI 1.003-2.119；P<0.05）。PtCA 组未破裂动脉瘤的数量为 862 例（39.4%），而 SBCA 组为 232 例（49.1%）。两组未破裂动脉瘤数量的差异有统计学意义（P<0.001）。与翼点入路相比，SBCA 术中破裂率显著降低。
与翼点入路相比，破裂动脉瘤采用 SBCA 治疗时术中破裂率显著升高。然而，SBCA 可能对未破裂和大脑中动脉动脉瘤更安全，其术中破裂率较低。
