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

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 I ² 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; I ²  = 0%), overall surgical complications (OR 0.45, 95% CI: 0.21-0.99; I ²  = 72%), and operation time (MD - 54.42 min, 95% CI: -60.78 to - 48.06; I ²  = 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; I ²  = 0%). However, there was no significant difference in length of stay between groups (MD - 1.52 days, 95% CI: -3.75 to 0.72; I ²  = 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.
Competing Interests: Declarations. Ethics approval and consent: 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. Competing interests: The authors declare no competing interests.
(© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)