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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 278-284
DOI: 10.4103/ajns.AJNS_25_19
Original article

The keyhole approach in anterior circulation aneurysm – Current indication and limitation with review of literature

Lavlesh Rathore
Department of Neurosurgery, Shri Balaji Institute of Medical Sciences, Raipur, Chhattisgarh
,
Yashiro Yamada
1   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Tsukasa Kawase
1   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Yoko Kato
1   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Satya Senapati
2   Department of Neurosurgery, SMIMS, Gangtok, Sikkim
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Introduction: The keyhole approach has been an emerging technique for cerebral aneurysm surgery in the past two decades. The preoperative simulation and tailored-made approach for each patient make feasible to clip many cerebral aneurysms via keyhole approach. In our study, we reviewed the previous experiences of the keyhole approach, related specifically for anterior circulation aneurysm. Material and Methods: The comprehensive literature review was performed on PubMed, Google Scholar, ScienceDirect, and various neurosurgery and neurology journals. Then, each manuscript's reference list was reviewed for the potential relevant article. The data of total 17 articles, which met our inclusion criteria included for the final review. Results: It was found that the anterior communicating artery, middle cerebral artery, and internal carotid- posterior communicating aneurysms were the most common locations treated by keyhole approach. The size of an aneurysm was <10 mm in most of the studies. Many studies treated multiple aneurysms by single keyhole approach. Conclusion: The keyhole approach has shown benefit in term of satisfactory aneurysmal occlusion rate, short operative time, less blood loss, short hospital stay, and good overall surgical outcome.

Key-words:

Commonest anterior circulation aneurysm treated by keyhole approach - complete occlusion rate - hospital stay - keyhole approach for anterior circulation aneurysm

Financial support and sponsorship

Nil.




Publication History

Received: 28 January 2019

Accepted: 30 September 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: Its origins and evolution. Minim Invasive Surg 2013;2013:296469.
  • 2 Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, Spetzler RF, et al. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. J Clin Neurosci 2016;27:34-9.
  • 3 Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Fujii K, et al. Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms. J Neurosurg 2017;127:1307-14.
  • 4 Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Tomura S, et al. Long-term neurological and radiological results of consecutive 63 unruptured anterior communicating artery aneurysms clipped via lateral supraorbital keyhole minicraniotomy. Oper Neurosurg (Hagerstown) 2018;14:95-103.
  • 5 Mitchell P, Vindlacheruvu RR, Mahmood K, Ashpole RD, Grivas A, Mendelow AD. Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms. Surg Neurol 2005;63:47-51.
  • 6 Park J, Woo H, Kang DH, Sung JK, Kim Y. Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation. Neurosurgery 2011;68:300-9.
  • 7 Caplan JM, Papadimitriou K, Yang W, Colby GP, Coon AL, Olivi A, et al. The minipterional craniotomy for anterior circulation aneurysms: Initial experience with 72 patients. Neurosurgery 2014;10 Suppl 2:200-6.
  • 8 Yu L-H, Yao P-S, Zheng S-F, Kang D-Z. Retractorless surgery for anterior circulation aneurysms via pterional keyhole approach. World Neurosurgery 2015;84:1779-84.
  • 9 Tang C, Sun J, Xue H. Supraorbital keyhole approach for anterior circulation aneurysms. Turkish Neurosurgery 2013;23: 434-38.
  • 10 Chen L, Tian X, Zhang J, Huang Y, Chen E, Lan Q, et al. Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage: A prospective study at a single institute. Acta Neurochir (Wien) 2009;151:781-4.
  • 11 Cheng W-Y, Lee H-T, Sun M-H. A pterion keyhole approach for the treatment of anterior circulation aneurysms. Minim Invasive Neurosurg 2006;49:257-62.
  • 12 Tang Y, Chen H, Ma F, Scharnweber R, Zhang J, Chen G, et al. Experience using the pterional keyhole approach for the treatment of ruptured intracranial aneurysms of the anterior circulation. World Neurosurg 2018;118:e800-e805.
  • 13 Bhatoe HS. Transciliary supraorbital keyhole approach in the management of aneurysms of anterior circulation: Operative nuances. Neurol India 2009;57:599-606.
  • 14 Yamahata H, Tokimura H, Tajitsu K, Tsuchiya M, Taniguchi A, Hirabaru M, et al. Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms. Neurosurg Rev 2014;37:629-36.
  • 15 Tra H, Huynh T, Nguyen B. Minipterional and supraorbital keyhole craniotomies for ruptured anterior circulation aneurysms: Experience at single center. World Neurosurg 2018;109:36-9.
  • 16 Js P, Mw B, Is P. Risk Factor Analysis for Poor Outcomes in Supraorbital Keyhole Aneurysm Clipping for Ruptured Anterior Circulation. World Neurosurg 2018;111:e386-9.
  • 17 Mori K. Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg 2014;9:14-20.
  • 18 Park J. Superciliary keyhole approach for unruptured anterior circulation aneurysms: Surgical technique, indications, and contraindications. J Korean Neurosurg Soc 2014;56:371-4.
  • 19 Dott NM. Intracranial aneurysms: Cerebral arterio-radiography: Surgical treatment. Edinb Med J 1933;40:T219-T240.
  • 20 Dandy WE. Intracranial aneurysm of the internal carotid artery: Cured by operation. Ann Surg 1938;107:654-9.
  • 21 Krayenbühl HA, Yaşargil MG, Flamm ES, Tew JM Jr. Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 1972;37:678-86.
  • 22 Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: Technical note. Neurosurgery 1982;11:537-42.
  • 23 Paladino J, Pirker N, Stimac D, Stern-Padovan R. Eyebrow keyhole approach in vascular neurosurgery. Minim Invasive Neurosurg 1998;41:200-3.
  • 24 Fries G, Perneczky A. Endoscope-assisted brain surgery: Part 2 – Analysis of 380 procedures. Neurosurgery 1998;42:222-6.
  • 25 Cho WS, Kim JE, Kang HS, Son YJ, Bang JS, Oh CW, et al. Keyhole approach and neuroendoscopy for cerebral aneurysms. J Korean Neurosurg Soc 2017;60:275-81.
  • 26 Zheng X, Liu W, Yang X, Gong J, Shen F, Shen G, et al. Endoscope-assisted supraorbital keyhole approach for the resection of benign tumors of the sellar region. Minim Invasive Ther Allied Technol 2007;16:363-6.
  • 27 Mathuriya SN. Endoscopic keyhole technique for anterior circulation aneurysms: Present status. Neurol India 2015;63:829.
  • 28 Thompson BG, Brown RD Jr., Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr., et al. Guidelines for the management of patients with unruptured intracranial aneurysms: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:2368-400.
  • 29 Pierot L, Spelle L, Vitry F; ATENA Investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: Results of the ATENA study. Stroke 2008;39:2497-504.
  • 30 Sharma BS, Kumar A, Sawarkar D. Endoscopic controlled clipping of anterior circulation aneurysms via keyhole approach: initial experience. Neurol India 2020.
  • 31 Chalouhi N, Jabbour P, Ibrahim I, Starke RM, Younes P, El Hage G, et al. Surgical treatment of ruptured anterior circulation aneurysms: Comparison of pterional and supraorbital keyhole approaches. Neurosurgery 2013;72:432-7.
  • 32 Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF. Treatment of unruptured intracranial aneurysms: A nationwide assessment of effectiveness. AJNR Am J Neuroradiol 2007;28:146-51.
  • 33 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-10.
  • 34 Ha H-G. Keyhole approaches in neurosurgery. Volume 1: Concepts and surgical technique. Korean Neurosurg Soc 2009;45:132.
  • 35 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005;57:(suppl_4):ONS-242-ONS-255. Available from: https://doi.org/10.1227/01.NEU.0000178353.42777.2C. [Last accessed on 2005 Oct 01].