Versatilidad y eficacia del acceso minipterional en aneurismas cerebrales. Experiencia de 200 casos.

Abstract

The minipterional access has shown advantages over the classic pterional, as well as other minimally invasive accesses. The variant of the minipterional access with interfascial flap was described, and its combination with skull base techniques, for the resolution of aneurysmal pathologies not only of the anterior circulation but also of the posterior circulation, and other pathologies of the skull base. Microsurgical therapy in cerebral aneurysms is a fundamental pillar, demonstrating safety and efficacy in various international publications, as well as some advantages over endovascular treatment. A tabulation and analysis of a prospective database of cerebral aneurysms operated on by the main author of the work in two centers between 2017 and 2022 was carried out, obtaining a total of 200 cases; the clinical result was obtained as favorable or unfavorable based on the modified Rankin scale. In the results there was a female predominance with 57.5% (115 cases),

with an average age of 63 years. 70% (140 patients) were ruptured aneurysms, and 97% anterior circulation. The functional clinical result was analyzed in the two groups separately, ruptured and non-ruptured aneurysms; statistical tests were applied to the results. The exponential growth of endovascular treatment in the treatment of cerebral aneurysms has demanded greater efforts from microsurgical neurosurgeons in search of minimal invasion and obtaining good results. Regarding the minipterional access in aneurysmal pathology, it has proven to be versatile and effective. The series shows the clinical and imaging results, according to the standard technique described, for the management of anterior circulation aneurysms, and a few of posterior circulation; evidencing an adequate clinical and imaging outcome in a large percentage of patients, according to the modified Rankin scale and neuroimaging, in a medium-term follow-up, showing the safety and efficacy of the treatment carried out in a regional center in Chile.