Standard Orbitozygomatic Craniotomy vs Mini Orbitozygomatic Craniotomy via an Eyebrow Incision for Microsurgical Treatment of Anterior Communicating Artery Aneurysms

BACKGROUND: Skull base approaches are utilized to improve microsurgical treatment of cerebral aneurysms. Advantages include early proximal and distal control, increased visualization, and minimal brain retraction. Orbitozygomatic (OZ) craniotomies via pterional incision are commonly used for the treatment of anterior communicating artery (ACoA) aneurysms. A smaller, less invasive OZ craniotomy performed through an eyebrow incision may provide several advantages over a standard OZ approach. OBJECTIVES: We compare surgical outcomes of the standard and eyebrow OZ for the treatment of ACoA aneurysms. DESIGN: All patients who underwent microsurgical treatment for ACoA aneurysms by a single surgeon over an 8-year period were included in this retrospective analysis. Patient demographics and clinical data were collected. PARTICIPANTS: 37 consecutive patients were identified, with 15 receiving eyebrow OZ and 22 receiving standard OZ. MAIN OUTCOME MEASURES: Data was collected on patient demographics, pathology, intraoperative and perioperative data, and 30-day morbidity. RESULTS: 100% of the eyebrow OZ group and 95.5% of the standard OZ group had complete aneurysmal occlusion. 4 eyebrow OZ and 6 standard OZ patients had an intraoperative rupture. All were managed without complication. 2 eyebrow OZ and 1 standard OZ patient died within 30 days of surgery. No patients in either group had aneurysm recurrence, required re-treatment, or were limited intraoperatively by exposure. CONCLUSIONS: The OZ approach via an eyebrow incision has similar outcomes to a standard OZ approach and is a safe option for the treatment of ACoA aneurysms.