To reduce surgical invasiveness, the supraorbital keyhole approach was applied to the treatment of cerebral aneurysms in the anterior circulation. Twenty-four aneurysms in 22 patients were treated with the keyhole craniotomy placed in the supraorbital area. Preoperative CT angiography was evaluated to determine the optimal side of the craniotomy and feasibility of the surgery according to the predicted direction of clip insertion. The clipping was accomplished in all cases without major complications. The postoperative mRS grade was 0 in 18 patients (82%), 1 in 2 patients (9%) and 5 in 2 patients (9%).
Though careful case selection is an essential prerequisite, clipping of the anterior circulation aneurysm is feasible with the supraorbital keyhole approach with reduced surgical invasiveness.