Hyaluronidase Injection to Reduce Periorbital Edema after Surgery for Unruptured Intracranial Aneurysms

Background: In the era of endovascular treatment for intracranial aneurysms, microsurgical treatment might necessitate the minimization of postoperative discomforts such as headache, nausea, vomiting, and edema. The current study aimed to evaluate the effectiveness of hyaluronidase on the reduction of periorbital edema after clipping surgery for unruptured intracranial aneurysms. Methods: From July 2016 to March 2018, the patients who underwent elective surgery for unruptured intracranial aneurysms were included. A mixture of 4500 IU hyaluronidase was injected subcutaneously on the sectional plane of the scalp incision. The photographs of patients’ faces were obtained on postoperative day 1, 3, and 7. The degree of periorbital edema was judged on the grading system based on the vertical palpebral aperture. The thickness of the scalp, temporalis muscle, and soft tissue was measured on a preoperative computed tomography (CT) scan, and other variables (e.g., intraoperative input and output, serum albumin level) were Results: A total of 60 patients were included in this study, and a hyaluronidase mixture was injected in 30 patients. The periorbital edema tended to resolve in 7 days after surgery, but notable differences between the two groups was observed at day three after surgery in this study. On the ordinal logistic regression analysis on the grade of periorbital edema, hyaluronidase injection is significantly associated with the reduction of periorbital edema throughout the postoperative period. (p value < 0.05)Conclusion: Hyaluronidase injection might be helpful in reducing periorbital edema after surgery for unruptured intracranial aneurysms.