Lateral Supraorbital Keyhole Approach to Clip Unruptured Anterior Communicating Artery Aneurysms

Abstract

Clipping of an anterior communicating artery (A-com A) aneurysm requires various working angles for safe manipulation and observation. The lateral supraorbital keyhole approach provides a more lateral subfrontal corridor to observe and clip an A-com A aneurysm than the standard Perneczky method. Preoperative planning was individualized in each patient based on three-dimensional computed tomography (3D-CT) angiography and 3D-CT osteotomy planning images. The procedure consisted of a 40-50 mm periorbital skin incision, partial dissection of the anterior portion of the temporal muscle, a 35 x 25 mm keyhole minicraniotomy from the supraorbital area to the sphenoid ridge, and opening of the carotid cistern and sylvian fissure in an antegrade fashion. Ten keyhole clipping procedures were performed in 10 patients with unruptured A-com A aneurysms. No shaving of scalp hair, drain placement, or anticonvulsant medication were required. No patient suffered neurological deficits or abnormal findings on postoperative magnetic resonance imaging. Most patients were discharged on the 2nd to 3rd postoperative days except for one patient who suffered from meningitis. The lateral supraorbital keyhole approach is a minimally invasive treatment option for relatively small and unruptured A-com A aneurysms.