Background:
Haemorrhagic strokes represent 13% of cerebrovascular accidents. The most common cause of spontaneous subarachnoid haemorrhage is a ruptured cerebral aneurysm. Current treatment options include surgical and endovascular management. Novel minimally invasive approaches to aneurysm clipping have been developed to enhance recovery. These include mini-pterional, supraorbital and lateral supraorbital minicraniotomy.
Methods:
The aim of this systematic review is to compare patient outcomes following standard pterional craniotomy versus minicraniotomy for surgical clipping of ruptured or unruptured cerebral aneurysms. Searches were undertaken on Pubmed and Ovid Embase databases following PRISMA guidelines. Outcomes of interest include length of stay, functional recovery using the modified Rankin score (mRS), operative time and cosmetic outcomes.
Results:
2303 studies were retrieved, with 25 studies included for meta-analysis including 2 RCTs and 23 observational studies. Risk of bias was assessed using ROBIN-1 and ROB-2 tools. A total of 4140 patients were included with a 1.86 female to male ratio. Mean age was 57 years and mean aneurysm size was 6.3mm. The average length of stay was 9.9 days for minicraniotomy patients compared to 13.7 days in the standard craniotomy group (p<0.01). Operative time and mRS scores were also improved in the minimally invasive group (p<0.05) with no difference in complete aneurysm occlusion rate between the two groups (p=0.30).
Conclusion:
Minicraniotomy approaches provide advantages for patients with ruptured and unruptured aneurysms, including shorter hospitalisation and improved functional recovery, without compromising complete aneurysm occlusion. Limitations include careful selection bias of suitable patients for this approach and most studies being retrospective.