Comparison between frontolateral approach and pterional approach in the surgical treatment of paraclinoid aneurysms.

Objective: To compare the pterional and frontolateral approach to determine the most effective route for paraclinoid aneurysm surgery.

Methods: Between June 2010 and December 2015, a total of 176 patients with paraclinoid aneurysm underwent surgical clipping, 96 through the pterional and 80 through the frontolateral approach. We analyzed the two groups and compared demographic, radiologic, and clinical variables including age, sex, aneurysm type,intraoperative rupture rates, operative time,anatomical obstacles,outcome and postoperative complications.

Results: The 2 groups were comparable with respect to baseline characteristics. The mean operation time was also signifcantly shorter in frontolateral group than in the pterion group (204.3 min vs. 264.1 min, p < 0.05). Furthermore, the mean craniotomy area was much smaller in the frontolateral group (1255.4 mm vs. 2758.5 mm, p < 0.05). No patient experienced rebleeding in either group. In the frontolateral group, the exploration allows enough room for intracranial manipulation with maximal protection of the brain and other intracranial structures.

Conclusion: The frontolateral approach is a simple, reliable, and efficient procedure. The frontolateral approach could be a good alternative to the classic pterional approach for the treatment of paraclinoid aneurysms.