J Korean Neurosurg Soc.  2020 Jan;63(1):4-13. 10.3340/jkns.2019.0042.

Supraorbital Keyhole Approach for Intracranial Aneurysms : Transitioning from Concerns to Confidence

• Park J

• KMID: 2501688
• DOI: http://doi.org/10.3340/jkns.2019.0042

Abstract

For surgical minimalism to reduce iatrogenic traumatization, a supraorbital keyhole approach has already been successfully applied to treat many unruptured anterior circulation aneurysms. However, using this minimal approach also raises several technical concerns due to the small cranial opening and cosmetic impact of a facial incision. Yet, such technical limitations can be overcome by using favorable surgical indications, slender surgical instruments, and optimized surgical techniques, while excellent cosmetic outcomes can be achieved using a short skin incision located <1 cm from the supraorbital margin, reconstruction of any bone defects around the bone flap, and meticulous wound closure. Thus, given such reassuring surgical results, in terms of the clipping status, neurological effects, and cosmetic outcomes, any concerns can be transitioned into confidence.

Keyword

Craniotomy; Intracranial aneurysm; Minimally invasive surgical procedures

Figure

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  Fig. 1. Cranial opening for ICA and ACoA aneurysms. Dotted line is dural incision. ICA : internal carotid artery, ACoA : anterior communicating artery.

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  Fig. 2. Cranial opening for MCA aneurysms. Dotted line is dural incision. MCA : middle cerebral artery.

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  Fig. 3. Location of the brain spatula applied to the inferior surface of the frontal lobes in a supraorbital keyhole approach and pterional approach for ACoA aneurysms. ACoA : anterior communicating artery.

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  Fig. 4. Single-shaft slender-type surgical instruments, including microforceps, microscissors, bipolar coagulator, and aneurysm clip applier.

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  Fig. 5. Long and short bipolar coagulation forceps. The long bipolar coagulation forceps have a narrower configuration in the anterior part. Arrows indicate the width of the bipolar coagulation forceps at the level of the craniotomy opening.

Reference

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