LAUSR

BACKGROUND Minimally invasive craniotomy (MIC) for ruptured aneurysm remains a debatable issue because of unclear information regarding its safety and efficacy compared to the standard approaches. Here, we compared the outcomes between MIC and pterional craniotomy (PTC) for the treatment of ruptured anterior circulation aneurysms. METHOD A database of ruptured anterior circulation aneurysm patients who were treated with surgical clipping was reviewed. With the use of propensity score matching to balance the baseline characteristics of MIC and PTC groups, outcomes of the two groups were compared. Clinical predictors of favorable outcomes (Modified Rankin Scale 0-2) were evaluated by using univariate and multivariate analyses. RESULTS A total of 102 matched pairs were identified. MIC resulted in a significantly shorter operative time (2.8 ± 0.9 h vs 4.2 ± 0.7 h; P = 0.004) and hospital stay (14.2 ± 5.9 days vs 19.2 ± 9.1 days; p < 0.001). Both MIC and PTC had similar mortality and complication rates except for the incidences of intracranial hemorrhage (2% vs 9.8%; P = 0.039) and brain injury (9.8% vs 27.5%; P = 0.036). Use of MIC instead of standard surgery as well as lower WFNS grade, and absence of hydrocephalus were significant predictors of favorable outcome at 1 month whereas higher WFNS grade and higher Fisher grade were significantly associated with a poor outcome at 6 months. CONCLUSIONS For the treatment of ruptured anterior circulation aneurysms, MICs were comparable to PTC and presented additional advantage in term of earlier recovery. Therefore, MICs can be considered an alternative surgical treatment in this setting.