Postoperative patient experience following different minimally invasive surgical approaches for unruptured intracranial aneurysms: Superciliary approach versus trans-scalp lateral supraorbital approach.

OBJECTIVE

This prospective study compared postoperative patient experience between the superciliary approach (supra-eyebrow incision) and the trans-scalp lateral supraorbital approach (scalp incision) for unruptured anterior circulation aneurysms.

METHODS

Patients (n=111) undergoing a superciliary or trans-scalp lateral supraorbital approach completed a six-item daily Visual Analogue Scale (VAS) symptom questionnaire (wound-related pain, generalized headache, depressed mood, fatigue, decreased appetite, and nausea) and underwent neurological examinations for 5 days postoperatively.

RESULTS

Surgical outcomes, including clip placement adequacy and complications, did not differ between groups. On postoperative day (POD) 5, the superciliary group reported significantly less wound-related pain (3.34 vs. 4.70, p=0.003), headache (3.54 vs. 5.16, p=0.001), depressed mood (2.33 vs. 3.44, p=0.018), fatigue (3.11 vs. 4.46, p=0.009), and decreased appetite (3.61 vs. 5.00, p= 0.007) than the trans-scalp group. Stepwise regression identified the trans-scalp approach as a dominant predictor of wound-related pain, headache, depressed mood, and fatigue. Significant mood depression (VAS ≥5) occurred in 10 patients (16.4%) in the superciliary group versus 17 (34.0%) in the trans-scalp group on POD 5, and depressed mood correlated significantly with fatigue, decreased appetite, nausea, and headache.

CONCLUSIONS

The superciliary approach was associated with less postoperative pain and discomfort than the trans-scalp lateral supraorbital approach in the early period after successful aneurysm clipping. The trans-scalp approach was a dominant determinant of wound-related pain, headache, depressed mood, and fatigue, and depressed mood correlated with other postoperative symptoms in both groups.