Postoperative Symptoms and Patient Satisfaction After Standard or Minimally Invasive Pterional Craniotomy for Intracranial Aneurysms

Objective: Microsurgical approaches for intracranial aneurysms are more invasive than endovascular treatments and are associated with longer recovery periods and worse cosmetic outcomes. To reduce the significant surgical burden on patients, neurosurgeons have developed more refined techniques. In this study, headache rates and postoperative scar satisfaction were compared between standard pterional and minipterional craniotomies for anterior circulation aneurysm clipping. Methods: A single-institution, mixed prospective and retrospective cohort study of patients treated by a single surgeon from 2018 to 2021 was conducted. Headache rate and severity were preoperatively and postoperatively measured with the Migraine Disability Assessment Test (MIDAS) and the Headache Impact Test (HIT-6). Secondary outcomes included cosmetic outcomes, assessed by the SCAR-Q questionnaire, and health function, measured by the 36-Item Short-Form Health Survey (SF-36) and the Patient Global Impression of Change (PGIC). Results: Of the 36 patients enrolled (25 (69%) women, 11 (31%) men; mean age: 64.9 (range: 34-82) years), 21 underwent standard pterional craniotomy, and 15 underwent minipterional craniotomy. No significant difference was found in HIT-6 and MIDAS grade between approaches; however, a larger percentage of patients in the standard pterional group than in the minipterional group reported severe disability three months postoperatively. All standard-approach patients reported a moderate change in PGIC, but patients in the minipterional group reported the greatest improvement in clinical status. Both groups had similar postoperative headache rates. Patients in the minipterional group had significantly better outcomes for scar appearance than patients in the standard pterional group (p=0.03). Conclusion: The minipterional approach offered cosmetic advantages without worsening headache burden. Although the sample size and follow-up rates were limited, the results support this less invasive approach as a patient-centered alternative. This work highlights the importance of tailored treatment for brain lesions and offers insight into ways to achieve optimal patient outcomes.