Pterional Keyhole Craniotomy by Using Electromagnetic Navigation for Aneurysm Clipping

Abstract

Keyhole craniotomy is a minimally invasive method for microsurgical clipping. We describe a simple and easy pterional keyhole craniotomy (PKC) technique for clipping using an electromagnetic navigation system (the AxiEM Electromagnetic StealthStation navigation system, Medtronic, Minneapolis, MN, USA). We used the freehand technique with the emitter throughout the procedure to avoid electromagnetic interference from the metallic surgical instruments, which serves as a potential disadvantage of the electromagnetic navigation system. Navigation-guided surgery enables accurate PKC and provides sufficient working space for complete and meticulous clipping. The electromagnetic navigation system setup and subsequent registration can be performed rapidly, does not require special instruments, and is available at all facilities that have an electromagnetic navigation system.