www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2012.51.6.334 J Korean Neurosurg Soc 51 : 334-337, 2012 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright © 2012 The Korean Neurosurgical Society Clinical Article Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms Ki-Chul Cha, M.D., Seung-Chyul Hong, M.D., Ph.D., Jong-Soo Kim, M.D., Ph.D. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Objective : The lateral supraorbital (LSO) approach is a modified method of the classic pterional approach and it has advantages of short skin inci- sion and small craniotomy compared with the pterional approach. This study was designed to compare the two approaches in the surgical treat- ment of unruptured intracranial aneurysms. Methods : We retrospectively reviewed 122 patients with 137 unruptured intracranial aneurysms treated by clipping, from July 2009 to April 2011. Between August 2010 and April 2011, 61 patients were treated by clipping via the lateral supraorbital approach and the same number of patients treated by clipping via the pterional approach were retrospectively enrolled. We analyzed the two groups and compared demographic, radiologic and clinical variables. Results : The mean age of patients in the two groups was 54.6 years (LSO group) and 55.7 years (Pterion group). The mean duration of hospitalization was shorter in the LSO group than in the Pterion group (7.9 days vs. 9.0 days, p=0.125) and the mean operation time was also significantly shorter in the LSO group (117.1 minutes vs. 164.3 minutes, p<0.001). Furthermore, the mean craniotomy area was much smaller in the LSO group (1275.4 mm2 vs. 2858.9 mm2, p<0.001). The two groups showed similar distributions of aneurysm location and postoperative complications. Conclusion : The lateral supraorbital approach for the clipping of unruptured intracranial aneurysm could be a good alternative to the classic pteri- onal approach. Key Words : Supraorbital approach · Pterional approach · Aneurysm · Clipping. INTRODUCTION Since it has been introduced by Yasargil in the 1970s11), the pterional or the fronto-temporo-sphenoidal approach has been widely used to approach lesions of the sellar or suprasellar re- gion, Circle of Willis and Sylvian fissure. Although the standard pterional approach has been accepted as a safe and appropriate method for various intracranial lesions, several modified approaches, such as the supraorbital eyebrow incision approach9), the mini-pterional approach1), the mini-su- praorbital approach2), and the lateral supraorbital approach3), have been recently introduced and used as an alternative for the purpose of reduction in brain exposure to the non-physiological surroundings, such as room air, irrigation media, and accidental surgical trauma. The lateral supraorbital approach was proposed for operation on intracranial lesions located not only in the sellar and supra- sellar regions, but also in the Sylvian fissure and retro-sellar re- gions3). This modified approach requires much shorter skin inci- sion and much smaller craniotomy than the standard pterional approach. Furthermore, it causes less trauma to the temporalis muscle and no injury to the upper branch of the facial nerve. This study aimed to compare the lateral supraorbital approach with the pterional approach in the surgical treatment of unrup- tured aneurysms in the anterior circulation. MATERIALS AND METHODS Enrolled patients Between August 2010 and April 2011, we clipped 86 intracra- • Received : September 26, 2011 • Revised : November 21, 2011 • Accepted : January 25, 2012 • Address for reprints : Ki-Chul Cha, M.D. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel : +82-2-3410-0243, Fax : +82-2-3410-0048, E-mail : nsdrckc@naver.com • This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 334