Comparative study of the refined mini-pterional approach with reduced skin incision versus the conventional mini-pterional approach for clipping unruptured middle cerebral artery aneurysms: a propensity score-matched analysis.

This study aimed to compare the safety and efficacy of the refined mini-pterional approach (rMP), utilizing a smaller skin incision, with the conventional mini-pterional approach (cMP) for microsurgical clipping of unruptured intracranial aneurysms (UIAs) in the middle cerebral artery (MCA). A retrospective cohort analysis was conducted, including 186 patients: 92 patients who underwent rMP between 2021 and 2022, and 94 patients treated with cMP between 2019 and 2020. Clinical outcomes included length of stay (LOS, days), operative time (minutes), intraoperative blood loss (ml), aneurysm obliteration rate, postoperative complication rates, and the severity of temporalis muscle atrophy (TMA). Propensity score matching (PSM) was employed to minimize selection bias and ensure comparability of baseline characteristics between the two cohorts. Following PSM, the rMP group demonstrated significantly reduced LOS (cMP, 4.76 ± 2.32 days vs. rMP, 3.25 ± 1.10 days; p < 0.001), shorter operative time (cMP, 166.86 ± 51.62 min vs. rMP, 119.03 ± 33.71 min; p < 0.001), and lower intraoperative blood loss (cMP, 396.36 ± 392.04 ml vs. rMP, 225.75 ± 149.56 ml; p = 0.001) compared to the cMP group. There were no statistically significant differences in aneurysm obliteration rates or postoperative complication rates between the two approaches. The degree of TMA showed a favorable trend in the rMP cohort. The rMP offers significant advantages over the cMP in MCA UIA clipping, including shorter LOS, reduced operative time, lower intraoperative blood loss, and less severe TMA, without compromising aneurysm obliteration or increasing complication rates. These findings suggest that the rMP is a safe and effective alternative to the cMP for MCA aneurysm clipping.