Comparative Analysis of Tailored Minicraniotomy versus Standard Pterional Craniotomy in the Treatment of Anterior Circulation Aneurysms: A Single-Center Case-Control Observational Study.

Introduction: Multiple minicraniotomies (Mct) have been proposed as alternatives to standard pterional craniotomy (Pct) for intracranial aneurysm treatment. These approaches offer limited surgical corridors and distinct working angles, posing challenges in addressing all aneurysm types with one method. We suggest a tailored Mct technique, comprising three minimally invasive approaches targeting anterior circulation aneurysm sites (middle cerebral artery, internal carotid artery, anterior communicating artery). Methods: We conducted a retrospective, case-control study at a single center comparing Pct and Mct outcomes for ruptured and unruptured aneurysms. Parameters evaluated included conversion rates to Pct or decompressive hemicraniectomy (DHC), intraoperative rupture (IOR), surgical complications, complete aneurysm exclusion, 6-month modified Rankin Scale (mRS) scores, and aesthetic outcomes using a visual analog scale. A total of 146 patients were included, with 103 in the Mct group and 43 in the Pct group, comparable in mean age, sex, and aneurysm topography. Hunt-Hess scores and Fisher grades were lower in the Mct group initially. Results: No cases required conversion from Mct to Pct or DHC. No significant differences were observed in IOR, surgical complications, and aneurysm exclusion rates between groups. The Mct group demonstrated better 6-month mRS scores and aesthetic outcomes. Conclusion: Our study indicates that tailored Mct is as safe and effective as standard Pct for intracranial aneurysms, with significant cosmetic benefits. Thus, tailored Mct can be considered a valuable alternative not only to Pct but also to other minimally invasive surgical methods for these aneurysms.