Infection and quality of life after local or full scalp shaving in microsurgical treatment for unruptured intracranial aneurysm sited in anterior circulation

Abstract Background Scalp shaving constitutes a crucial preoperative preparation measure for the microsurgical treatment of unruptured intracranial aneurysms (UIAs) located in the anterior circulation. This study aimed to investigate the infection and quality of life after local scalp shaving (LSS) or full scalp shaving (FSS) in microsurgery for UIAs in the anterior circulation. Methods This study included patients receiving microsurgical treatment for UIAs sited in the anterior circulation from a national, multicenter, prospective cohort study, conducted from December 2021 to December 2024. Propensity score matching was performed to form a nested case–control cohort regarding age, sex, diabetes mellitus, aneurysm site, and size, and surgical methods with a ratio of patients with LSS to patients with FSS as 1:2. The primary outcome was central nervous system infection within 90 days after surgery, and the secondary outcome was the Face-Q score on the 180th day after surgery. Logistic analysis was performed to compare the incidence of outcomes between LSS and FSS groups. Results This study finally included 2157 patients receiving microsurgical treatment for UIAs in the anterior circulation, with 908 males and a median age of 59 years. 719 patients were assigned to the LSS group and 1438 to the FSS group. No significant difference was found in the 90-day central nervous system infection (25 of 719 [3.5%] vs. 49 of 1438 [3.4%]; odds ratio, 0.98; 95%CI, 0.60–1.60; P = 0.933). Patients in the LSS group had a higher 180-day Face-Q score compared with patients in the FSS group (4 vs. 2; ordinary odds ratio, 0.43; 95%CI, 0.40–0.47; P < 0.001). Conclusion LSS is an appropriate preoperative scalp shaving protocol for patients receiving microsurgical treatment of UIAs sited in the anterior circulation, with no increasing risk of infection and improved quality of life after surgery. Trial registration ChTUIA cohort (China Treatment Trial for Unruptured Intracranial Aneurysm, unique identifier: NCT05844163, Clinicaltrials.gov registry)