Institutional Experience of Microsurgical Clipping for Anterior Circulation Aneurysms with Mini Pterional Craniotomy: A Cosmetic and Pivotal Innovation

Objective: To examine the functional outcome, complications, and aesthetic results with the mini pterional craniotomy for microsurgical clipping for anterior circulation aneurysms. Material & Methods: This study was conducted at Neurosurgery Unit II of Punjab Institute of Neurosciences Lahore by a single neurosurgical team with 10 years of experience in vascular neurosurgery. A total of 107 patients who fulfilled the inclusion criteria were included in the study. Mini pterional craniotomy was performed in all the selected patients. Data was analyzed for age, gender, location of the aneurysm, and Modified World Federation of Neurological Surgery grade (WFNS) (pre-op, post-op at 3 months). Data was also analyzed for post-op complications along with a subjective assessment of wound scars by patients according to a modified cosmesis scale. Results: Out of the total 107 patients, 64 (59.8%) were female while 43 (40.2%) were male. Aneurysm was located at the anterior communicating artery in 58 (54.2%) patients and at MCA in 39 (36.4%). The pre-op WFNS grade was 1 in 52 (48.5%) patients and grade 2 in 25 (23.3%) patients. The WFNS grade recorded at 3-month post-op follow-up was grade 1 in 66 (61.6%) patients and grade 2 in 11 (10.2%) patients. Seven (6.5%) patients developed hydrocephalus, 5 (4.6%) got meningitis and 4 (3.7%) developed neurological deficits. Conclusion: Mini pterional craniotomy has proven itself as a safe and effective surgical procedure. It can be applied to a variety of aneurysmal locations and has a low rate of complications and good outcomes