Comparative Analysis of Tailored Minicraniotomy versus Standard Pterional Craniotomy in the Treatment of Anterior Circulation Aneurysms: A Single-Center Case–Control Observational Study

Giosuè Dipellegrini; Riccardo Boccaletti; Anna Mingozzi; Elisa Sanna; Domenico Policicchio

doi:10.1055/a-2399-0008

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(05): 602-610
DOI: 10.1055/a-2399-0008

Original Article

Comparative Analysis of Tailored Minicraniotomy versus Standard Pterional Craniotomy in the Treatment of Anterior Circulation Aneurysms: A Single-Center Case–Control Observational Study

Authors

Giosuè Dipellegrini

¹Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, itaòy, Italy
Riccardo Boccaletti

¹Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, itaòy, Italy
Anna Mingozzi

²Department of Oncology, Medical Oncology Unit, University Hospital of Parma, parma, italy, Italy
Elisa Sanna

³Department of Medical, Surgical and Experimental Sciences, G&O Clinic, University of Sassari, Sassari, Italy
Domenico Policicchio

⁴Department of Neurosurgery, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Sassari, Italy

Abstract

Introduction

Multiple minicraniotomies (Mct) have been proposed as alternatives to standard pterional craniotomy (Pct) for intracranial aneurysm treatment. These approaches offer limited surgical corridors and distinct working angles, posing challenges in addressing all aneurysm types with one method. We suggest a tailored Mct technique, comprising three minimally invasive approaches targeting anterior circulation aneurysm sites (middle cerebral artery, internal carotid artery, anterior communicating artery).

Methods

We conducted a retrospective, case–control study at a single center comparing Pct and Mct outcomes for ruptured and unruptured aneurysms. Parameters evaluated included conversion rates to Pct or decompressive hemicraniectomy (DHC), intraoperative rupture (IOR), surgical complications, complete aneurysm exclusion, 6-month modified Rankin Scale (mRS) scores, and aesthetic outcomes using a visual analog scale. A total of 146 patients were included, with 103 in the Mct group and 43 in the Pct group, comparable in mean age, sex, and aneurysm topography. Hunt–Hess scores and Fisher grades were lower in the Mct group initially.

Results

No cases required conversion from Mct to Pct or DHC. No significant differences were observed in IOR, surgical complications, and aneurysm exclusion rates between groups. The Mct group demonstrated better 6-month mRS scores and aesthetic outcomes.

Conclusion

Our study indicates that tailored Mct is as safe and effective as standard Pct for intracranial aneurysms, with significant cosmetic benefits. Thus, tailored Mct can be considered a valuable alternative not only to Pct but also to other minimally invasive surgical methods for these aneurysms.

Keywords

minicraniotomy - minimally invasive neurosurgery - cerebral aneurysms - brain surgery - clipping

Full Text

References

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