Comparison of unilateral and bilateral craniotomy for the treatment of bilateral middle cerebral artery aneurysms: anatomical and clinical parameters and surgical outcomes

Abstract

ABSTRACT

Comparison of unilateral and bilateral craniotomy for the treatment of bilateral middle cerebral artery aneurysms: anatomical and clinical parameters and surgical outcomes Min Jai Cho Department of Medicine, Neurosurgery The Graduate School Seoul National University

Objective: To compare two craniotomy approaches (unilateral and bilateral) in terms of anatomical and clinical parameters and surgical outcomes.

Methods: From January 2011 to December 2014, at the Bundang Seoul National University Hospital, 19 patients with bilateral unruptured middle cerebral artery (MCA) aneurysms were treated with unilateral craniotomy (group 1) and 10 patients were treated with bilateral mini-craniotomy (group 2). We compared demographic data, characteristics of aneurysms, radiological and clinical parameters, postoperative complications, and surgical outcomes between the groups.

Results: No statistically significant differences were found in aneurysm characteristics between the two groups. Radiological parameters did not have any influence on surgical outcomes or the incidence of postoperative complications. Group 1 had a higher incidence of olfactory dysfunction (11/19, 58%) and residual neck at the contralateral aneurysm (10/19, 53%), while group 2 did not have olfactory dysfunction or residual neck at the contralateral aneurysm. There was a significant difference in the frequency of postoperative olfactory dysfunction between the two groups (P = 0.003). All patients in group 2 had good surgical outcomes (modified Rankin scale 0). The length of the hospital stay was similar in both groups. Conclusion: Bilateral mini-craniotomy for the treatment of bilateral MCA aneurysms was associated with better surgical outcomes and fewer complications. Bilateral mini-craniotomy does not require as much retraction of the frontal lobe to apply a clip completely at the contralateral aneurysm. Therefore, it represents a safe and effective therapeutic option for unruptured bilateral MCA aneurysms.

Key words: bilateral craniotomy, bilateral middle cerebral artery aneurysms, postoperative olfactory dysfunction, unilateral craniotomy Student number: 2016-21944