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Pterional vs. mini-pterional craniotomy for intracranial aneurysms: a systematic review and meta-analysis

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Abstract

The mini-pterional craniotomy (mPT) was designed to be a minimally invasive alternative to the standard pterional (PT) approach. However, it remains unclear which technique produces better results. Thus, we aimed to perform a meta-analysis comparing functional, surgical, and aesthetic outcomes between mPT and PT in intracranial aneurysms. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing mPT to PT in patients who underwent clipping of brain aneurysms until June 2024. Outcomes were modified Rankin Scale (mRS) or Glasgow Outcome Scale (GOS), surgical complications, operation time, length of stay, and patients’ aesthetic satisfaction. Statistical analysis was performed using the R software (version 4.4.0). Heterogeneity was assessed with I2 statistics. We included 6 studies with a total of 1011 patients, of whom 696 (63.1%) underwent mPT. The mean age was 59.0 ± 2.8 years, 67.6% were female, and 68.2% of all aneurysms were located in the middle cerebral artery. Unfavorable functional outcome (mRS ≥ 3 or GOS ≤ 3) at discharge (OR 0.21, 95% CI: 0.07–0.59; I2 = 0%), overall surgical complications (OR 0.45, 95% CI: 0.21–0.99; I2 = 72%), and operation time (MD − 54.42 min, 95% CI: −60.78 to − 48.06; I2 = 0%) were significantly lower in mPT compared to PT. Moreover, patients’ aesthetic satisfaction was statistically higher in mPT (OR 2.91, 95% CI: 1.06-8.00; I2 = 0%). However, there was no significant difference in length of stay between groups (MD − 1.52 days, 95% CI: −3.75 to 0.72; I2 = 72%). Mini-pterional craniotomy is associated with better functional outcomes at discharge, fewer surgical complications, and a shorter operation time. Therefore, our results might suggest that mPT is a promising and preferable alternative to standard PT.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ACoA:

Anterior communicating artery

CI:

Confidence interval

GOS:

Glasgow Outcome Scale

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

MD:

Mean difference

mPT:

Mini-pterional

mRS:

Modified Rankin Scale

OR:

Odds ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PT:

Pterional

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Federal University of Bahia, Salvador, Bahia, Brazil

    Marcos Paulo Rodrigues de Oliveira, Gabriel Teles de Oliveira Piñeiro, Davi Chaves Rocha de Souza, Pedro Henrique Ferreira Sandes & Gabriel Souza Medrado-Nunes

  2. Bahiana School of Medicine, Salvador, Bahia, Brazil

    Vanessa Emanuelle Cunha Santos

  3. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

    Michael T. Lawton

  4. Division of Neurosurgery, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Eberval Gadelha Figueiredo & Davi Jorge Fontoura Solla

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  1. Marcos Paulo Rodrigues de Oliveira
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Contributions

All authors contributed significantly to the study’s conception and design. M.P.R.O. developed the initial idea for the article. The comprehensive literature search was conducted by M.P.R.O., G.T.O.P., and V.E.C.S., ensuring a thorough review of relevant studies. Data extraction was performed by M.P.R.O., P.H.F.S., D.C.R.S., and V.E.C.S., who ensured the accuracy and completeness of the data collected. M.P.R.O. conducted the statistical analysis. The first draft of the manuscript was crafted by M.P.R.O., G.T.O.P., D.C.R.S., P.H.F.S., V.E.C.S., and G.S.M.N. The manuscript was critically reviewed by M.T.L., E.G.F. and D.J.F.S., who offered valuable feedback and revisions to enhance the quality and clarity of the work. All authors have read and approved the final manuscript, demonstrating their collective agreement on the study’s findings and conclusions.

Corresponding author

Correspondence to Marcos Paulo Rodrigues de Oliveira.

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As this study involved the analysis of secondary data obtained from previously published studies, formal ethics approval was not required. Additionally, since this meta-analysis utilized aggregated data, consent to participate from individual participants and consent for publication were not applicable.

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Oliveira, M.P.R., Piñeiro, G.T.O., Souza, D.C.R. et al. Pterional vs. mini-pterional craniotomy for intracranial aneurysms: a systematic review and meta-analysis. Neurosurg Rev 48, 36 (2025). https://doi.org/10.1007/s10143-025-03221-w

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