Anterior Communicating Artery Aneurysm Surgery through the Orbitopterional Approach: Long-Term Follow-Up in a Series of 75 Consecutive Patients

Objective: In this retrospective review of prospectively collected data, we report outcomes for patients with anterior communicating artery (ACoA) aneurysms treated via the orbitopterional approach and discuss the potential impact in patient outcomes by the reduction of surgery-induced brain damage. Methods: We retrospectively reviewed prospectively collected data from 40 men and 35 women (mean age, 50.8 years) who underwent clipping of ACoA aneurysms through the orbitopterional approach. Results: Overall outcomes at discharge using the modified Rankin Scale were good in 52 (69.4%) patients, fair in 13 (17.3%), and poor in 10 (13.3%). At last follow-up, outcomes were good in 63 (84%) patients, fair in 6 (8%), and poor in 6 (8%). Disability included none in 53.6% patients, mild in 10%, partial in 18.8%, moderate in 8.6%, moderately severe in 1.4%, severe in 2.9%, extremely severe in 2.9%, and vegetative state in 1.4%. Overall, 74% of patients returned to work after 4 months, 83% of previously unemployed patients returned to baseline, and 25% were disabled. Complications were more frequent and severe after subarachnoid hemorrhage. Conclusions: Long-term follow-up data present the orbitopterional approach as an attractive alternative for ACoA aneurysm surgery given the low rates of surgery-related morbidity and good patient outcomes and functionality.