2025 Volume 53 Issue 4 Pages 211-217
To preserve some of the benefits of traditional clipping surgery such as treatment durability, while pursuing a less invasive approach, we have performed supraorbital keyhole clipping surgery over a 17-year period since 2005. This procedure was conducted in a total of 137 cases of relatively small (mean: 6.0 ± 1.8 mm) unruptured intracranial aneurysms (UIAs). In the anterior circulation, comprising 74 anterior cerebral artery aneurysms and 63 internal carotid artery aneurysms. The mean patient age was 62.6 ± 9.5 years, and the mean craniotomy size was 28.5 ± 3.2 mm. The complete obliteration rate was 94.2%. The mean hospitalization time was 2.8 ± 4.4 days. Postoperative complications were two cases of lacunar infarction (1.5%), one of which (0.7%) was symptomatic (modified Rankin scale [mRS] = 3). Morbidity (mRS ＞2 or mini-mental state examination ＜24) occurred in one case (0.7 %) at 3 months. The mean neurological follow-up period was 6.9 ± 4.0 years, and postoperative mRS did not differ significantly from preoperative mRS. However, cognitive testing and depressive state were significantly improved 3 months postoperatively. The mean radiological follow-up period was 7.6 ± 4.2 years. Regrowth of neck remnants was noted in one of the eight cases (12.5%, 1.4%/year), while aneurysm recurrence occurred in three cases (2.1%, 0.29%/year). Two patients required retreatment (1.5%, 0.20%/year). Treatment of relatively small anterior circulation UIAs by keyhole clipping surgery ensured a good complete clipping rate and durability comparable with that of conventional craniotomy. Hospitalization was short, similar to that of endovascular surgery, and early psychological recovery was assured. We conclude that keyhole clipping is a viable less invasive surgical option.
