J Korean Neurosurg Soc.  2014 Nov;56(5):371-374. 10.3340/jkns.2014.56.5.371.

Superciliary Keyhole Approach for Unruptured Anterior Circulation Aneurysms: Surgical Technique, Indications, and Contraindications

• Park J

• KMID: 2018093
• DOI: http://doi.org/10.3340/jkns.2014.56.5.371

Abstract

Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.

Keyword

Cerebral aneurysm; Contraindications; Minimally invasive surgical procedures; Surgical technique

MeSH Terms

Aneurysm*
Intracranial Aneurysm
Surgical Instruments
Surgical Procedures, Minimally Invasive

Figure

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  Fig. 1 Skin incision (dotted line) for a superciliary approach.

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  Fig. 2 Underlying muscles related to an eyebrow skin incision (dotted line).

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  Fig. 3 Six retraction sutures placed at the edges of the skin incision after supraorbital mini-craniotomy.

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  Fig. 4 Catheter angiograms of aneurysms favorable for a superciliary approach. A : PCoA aneurysm (arrow) inducing oculomotor nerve palsy. B : Inferior-directing ACoA aneurysm (arrow). C : MCA aneurysm (arrow) with a maximum diameter of 14 mm. Note the relatively narrow neck. PCoA : posterior communicating artery, ACoA : anterior communicating artery, MCA : middle carotid artery.

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  Fig. 5 Catheter angiograms of aneurysms unfavorable for a superciliary approach. A : Aneurysm (arrow) at the posterior wall of the ICA requiring application of a right-angled fenestrated clip. B : High-positioned ACoA aneurysm (arrow). ICA : internal carotid artery, ACoA : anterior communicating artery.

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