J Cerebrovasc Endovasc Neurosurg.  2016 Mar;18(1):5-11. 10.7461/jcen.2016.18.1.5.

Modified Supraorbital Keyhole Approach to Anterior Circulation Aneurysms

  • 1Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea. nschan@gilhospital.com
  • 2Department of Radiation Oncology, Wonju College of Medicine, Yonsei University, Wonju, Korea.


To select a surgical approach for aneurysm clipping by comparing 2 approaches.
204 patients diagnosed with subarachnoid hemorrhage treated by the same neurosurgeon at a single institution from November 2011 to October 2013, 109 underwent surgical clipping. Among these, 40 patients with Hunt and Hess or Fisher grades 2 or lower were selected. Patients were assigned to Group 1 (supraorbital keyhole approach) or Group 2 (modified supraorbital approach). The prognosis according to the difference between the two surgical approaches was retrospectively compared.
Supraorbital keyhole approach (Group 1) was performed in 20 aneurysms (50%) and modified supraorbital approach (Group 2) was used in 20 aneurysms. Baseline characteristics of patients did not differ significantly between two groups. Total operative time (p = 0.226), early ambulation time (p = 0.755), length of hospital stay (p = 0.784), Glasgow Coma Scale at discharge (p = 0.325), and Glasgow Outcome Scale scores (p = 0.427) did not show statistically significant differences. The amount of intraoperative hemorrhage was significantly lower in the supraorbital keyhole approach (p < 0.05).
The present series demonstrates the safety and feasibility of the two minimal invasive surgical techniques for clipping the intracranial aneurysms. The modified supraorbital keyhole approach was associated with more hemorrhage than the previous supraorbital keyhole approach, but did not exhibit differences in clinical results, and provided a better surgical view and convenience for surgeons in patients with Hunt and Hess or Fisher grades 2 or lower.


Minimally invasive surgical procedures; Craniotomy; Intracranial aneurysm
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