Florez-Perdomo William A, Zabala-Otero Cesar E, Herrea Harrison R, Moscote-Salazar Luis Rafael, Abdulla Ebtesam, Janjua Tariq, Chaturvedi Jitender, Chouksey Pradeep, Agrawal Amit
Clinica Sahagún IPS, Sahagún, Córdoba, Colombia.
Faculty of Medicine, Universidad Surcolombiana. Neiva, Huila, Colombia.
World Neurosurg X. 2023 Apr 15;19:100177. doi: 10.1016/j.wnsx.2023.100177. eCollection 2023 Jul.
The supraorbital approach is a modification of the traditional pterional approach, and it offers the benefits of a shorter skin incision and a smaller craniotomy than the pterional approach. The purpose of this systemic review study was to compare the two surgical approaches for raptured and unruptured anterior cerebral circulation aneurysms.
We searched PubMed, EMBASE, Cochrane Library, SCOPUS, and MEDLINE, up to August 2021, for published studies on the supraorbital vs pterional keyhole approach for anterior cerebral circulation aneurysms, and reviewers performed a brief qualitative descriptive analysis of both approaches.
Fourteen eligible studies were included in this systemic review. Results indicated that the supraorbital approach for anterior cerebral circulation aneurysms had fewer ischemic events compared to pterional approach. However, no significant difference between both groups in terms of complications such as intraoperative aneurysm rupture, brain hematoma, and postoperative infections for ruptured aneurysms.
The meta-analysis suggests that the supraorbital method for clipping anterior cerebral circulation aneurysms might be a viable alternative to the traditional pterional method as the supraorbital group had decreased ischemic events compared to the pterional group, however, the associated difficulties in utilizing this approach among ruptured aneurysms with cerebral oedema and midline shifts further needs to be understood.
眶上入路是对传统翼点入路的一种改良，与翼点入路相比，它具有皮肤切口更短、开颅范围更小的优点。本系统评价研究的目的是比较这两种手术方法治疗破裂和未破裂的大脑前循环动脉瘤的效果。
我们检索了截至2021年8月的PubMed、EMBASE、Cochrane图书馆、SCOPUS和MEDLINE，以查找关于眶上与翼点锁孔入路治疗大脑前循环动脉瘤的已发表研究， reviewers对这两种入路进行了简要的定性描述性分析。
本系统评价纳入了14项符合条件的研究。结果表明，与翼点入路相比，眶上入路治疗大脑前循环动脉瘤的缺血事件更少。然而，在破裂动脉瘤的术中动脉瘤破裂、脑血肿和术后感染等并发症方面，两组之间没有显著差异。
荟萃分析表明，眶上入路夹闭大脑前循环动脉瘤可能是传统翼点入路的一种可行替代方法，因为与翼点入路组相比，眶上入路组的缺血事件减少了，然而，在伴有脑水肿和中线移位的破裂动脉瘤中使用这种入路的相关困难仍有待进一步了解。
