Oliveira Marcos Paulo Rodrigues de, Piñeiro Gabriel Teles de Oliveira, Souza Davi Chaves Rocha de, Sandes Pedro Henrique Ferreira, Santos Vanessa Emanuelle Cunha, Medrado-Nunes Gabriel Souza, Lawton Michael T, Figueiredo Eberval Gadelha, Solla Davi Jorge Fontoura
Federal University of Bahia, Salvador, Bahia, Brazil.
Bahiana School of Medicine, Salvador, Bahia, Brazil.
Neurosurg Rev. 2025 Jan 10;48(1):36. doi: 10.1007/s10143-025-03221-w.
The mini-pterional craniotomy (mPT) was designed to be a minimally invasive alternative to the standard pterional (PT) approach. However, it remains unclear which technique produces better results. Thus, we aimed to perform a meta-analysis comparing functional, surgical, and aesthetic outcomes between mPT and PT in intracranial aneurysms. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing mPT to PT in patients who underwent clipping of brain aneurysms until June 2024. Outcomes were modified Rankin Scale (mRS) or Glasgow Outcome Scale (GOS), surgical complications, operation time, length of stay, and patients' aesthetic satisfaction. Statistical analysis was performed using the R software (version 4.4.0). Heterogeneity was assessed with I statistics. We included 6 studies with a total of 1011 patients, of whom 696 (63.1%) underwent mPT. The mean age was 59.0 ± 2.8 years, 67.6% were female, and 68.2% of all aneurysms were located in the middle cerebral artery. Unfavorable functional outcome (mRS ≥ 3 or GOS ≤ 3) at discharge (OR 0.21, 95% CI: 0.07-0.59; I = 0%), overall surgical complications (OR 0.45, 95% CI: 0.21-0.99; I = 72%), and operation time (MD - 54.42 min, 95% CI: -60.78 to - 48.06; I = 0%) were significantly lower in mPT compared to PT. Moreover, patients' aesthetic satisfaction was statistically higher in mPT (OR 2.91, 95% CI: 1.06-8.00; I = 0%). However, there was no significant difference in length of stay between groups (MD - 1.52 days, 95% CI: -3.75 to 0.72; I = 72%). Mini-pterional craniotomy is associated with better functional outcomes at discharge, fewer surgical complications, and a shorter operation time. Therefore, our results might suggest that mPT is a promising and preferable alternative to standard PT.
微型翼点入路开颅术（mPT）旨在作为标准翼点入路（PT）的微创替代方法。然而，哪种技术能产生更好的效果仍不清楚。因此，我们旨在进行一项荟萃分析，比较mPT和PT在颅内动脉瘤治疗中功能、手术及美学方面的结果。我们在PubMed、EMBASE、科学网和考克兰图书馆中检索了截至2024年6月比较mPT和PT治疗脑动脉瘤夹闭术患者的研究。结局指标为改良Rankin量表（mRS）或格拉斯哥预后量表（GOS）、手术并发症、手术时间、住院时间及患者的美学满意度。使用R软件（版本4.4.0）进行统计分析。用I统计量评估异质性。我们纳入了6项研究，共1011例患者，其中696例（63.1%）接受了mPT。平均年龄为59.0±2.8岁，67.6%为女性，所有动脉瘤的68.2%位于大脑中动脉。出院时不良功能结局（mRS≥3或GOS≤3）（比值比0.21，95%置信区间：0.07 - 0.59；I = 0%）、总体手术并发症（比值比0.45，95%置信区间：0.21 - 0.99；I = 72%）及手术时间（平均差 - 54.42分钟，95%置信区间：-60.78至-48.06；I = 0%）在mPT组显著低于PT组。此外，mPT组患者的美学满意度在统计学上更高（比值比2.91，95%置信区间：1.06 - 8.00；I = 0%）。然而，两组间住院时间无显著差异（平均差 - 1.52天，95%置信区间：-3.75至0.72；I = 72%）。微型翼点入路开颅术与出院时更好的功能结局、更少的手术并发症及更短的手术时间相关。因此，我们的结果可能表明mPT是标准PT一种有前景且更可取的替代方法。
