• Raywat Noiphithak, Vich Yindeedej, Warot Ratanavinitkul, Gahn Duangprasert, Dilok Tantongtip, and Anusak Liengudom.
• Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. Electronic address: raywat_n@tu.ac.th.
• World Neurosurg. 2020 Jun 1; 138: e289-e298.

BackgroundMinimally invasive craniotomy (MIC) for ruptured aneurysm remains a debatable issue because of unclear information regarding its safety and efficacy compared with standard approaches. Here, we compared the outcomes between MIC and pterional craniotomy (PTC) for the treatment of ruptured anterior circulation aneurysms.MethodsA database of patients with ruptured anterior circulation aneurysm 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 2 groups were compared. Clinical predictors of favorable outcomes (modified Rankin scale score 0-2) were evaluated by using uni- and multivariate analyses.ResultsA total of 102 matched pairs were identified. MIC resulted in a significantly shorter operative time (2.8 ± 0.9 vs. 4.2 ± 0.7 hours; P = 0.004) and hospital stay (14.2 ± 5.9 vs. 19.2 ± 9.1 days; P < 0.001), respectively. 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), respectively. Use of MIC instead of standard surgery and lower World Federation of Neurosurgical Societies (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.ConclusionsFor the treatment of ruptured anterior circulation aneurysms, MIC was comparable with PTC and presented additional advantage in terms of earlier recovery. Therefore, MIC can be considered an alternative surgical treatment in this setting.Copyright © 2020 Elsevier Inc. All rights reserved.

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