Keyhole Approach in Anterior Circulation Aneurysm: Current Indication, Advantages, Technical Limitations, Complications and Their Avoidance

Overview

Journal J Cerebrovasc Endovasc Neurosurg

Date 2022 Mar 10

PMID 35263837

Authors

Hanuman Prajapati

Ahmad Ansari

Manish Jaiswal

Affiliations

Soon will be listed here.

Abstract

Keyhole surgery recently evolved as a minimal invasive surgical approach for treatment of anterior circulation aneurysm. This review was done to evaluate the keyhole approach for anterior circulation aneurysms, their indications, advantages, technical limitations, complications and their avoidance. The literature review was performed with the phrase "keyhole approach for anterior circulation aneurysm" as a search term in PubMed central, Medline, Google scholar and Embase data base to identify all the articles published till December 2020. Out of 113 articles searched, 22 were included in this review after screening for eligibility. On analyzing these articles, there was total 2058 aneurysm in 1871 patients. Out of 2058 aneurysm, 988 were ruptured and 547 unruptured. In 5 studies, which include 344 aneurysms in 344 cases, aneurysm ruptured or unruptured status was not specified. The most frequent aneurysm site was anterior communicating artery (n=573). The size of the aneurysm mentioned in most of the study was <15 mm. The rate of complete occlusion was ranged from 93.6-100%. The range of intra operative rupture (IOR) was 0-28.6%. The mean operative time was ranged from 70 min-5.34 hours as reported in 13 studies. Good outcome [Glasgow outcome scale (GOS): 4-5] were seen in 75-100% cases. The frontalis muscle weakness has been reported in 3 studies and ranged from 0-1.99%. Keyhole surgery can be a safe and effective treatment modality for treatment of a selected anterior circulation aneurysm. In the experienced hand it has certain advantages over standard pterional craniotomy.

Citing Articles

Validation of a dynamic 4D microsurgical bypass simulator for training and teaching microvascular anastomosis techniques with blood flow and fluorescence imaging.

Vanluchene H, Bervini D, Straughan R, Maina S, Joseph F World Neurosurg X. 2024; 24:100396.

PMID: 39399349 PMC: 11470790. DOI: 10.1016/j.wnsx.2024.100396.

The Mini-Spheno-Supraorbital Craniotomy for Treatment of Ruptured Anterior Circulation Aneurysms.

Nerntengian N, Tanrikulu L, Mavromati S, Gkasdaris G, Kourtopoulos H, Birbilis T Maedica (Bucur). 2022; 17(3):583-590.

PMID: 36540588 PMC: 9720642. DOI: 10.26574/maedica.2022.17.3.583.

References

Miyazawa T . Less invasive reconstruction of the temporalis muscle for pterional craniotomy: modified procedures. Surg Neurol. 1998; 50(4):347-51; discussion 351. DOI: 10.1016/s0090-3019(97)00345-5. View

Genesan P, Haspani M, Noor S . A Comparative Study between Supraorbital Keyhole and Pterional Approaches on Anterior Circulation Aneurysms. Malays J Med Sci. 2019; 25(5):59-67. PMC: 6419883. DOI: 10.21315/mjms2018.25.5.6. View

YASARGIL M, Boehm W, Ho R . Microsurgical treatment of cerebral aneurysms at the bifurcation of the internal carotid artery. Acta Neurochir (Wien). 1978; 41(1-3):61-72. DOI: 10.1007/BF01809137. View

Krayenbuhl H, YASARGIL M, Flamm E, TEW Jr J . Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg. 1972; 37(6):678-86. DOI: 10.3171/jns.1972.37.6.0678. View

Bhattarai R, Liang C, Chen C, Wang H, Huang T, Ning X . Supraorbital eyebrow keyhole approach for microsurgical management of ruptured anterior communicating artery aneurysm. Exp Ther Med. 2020; 20(3):2079-2089. PMC: 7401238. DOI: 10.3892/etm.2020.8909. View

Park J . Superciliary keyhole approach for unruptured anterior circulation aneurysms: surgical technique, indications, and contraindications. J Korean Neurosurg Soc. 2014; 56(5):371-4. PMC: 4272993. DOI: 10.3340/jkns.2014.56.5.371. View

Paladino J, Pirker N, Stimac D, Stern-Padovan R . Eyebrow keyhole approach in vascular neurosurgery. Minim Invasive Neurosurg. 1999; 41(4):200-3. DOI: 10.1055/s-2008-1052042. View

Choi Y, Son W, Park K, Park J . Intradural Procedural Time to Assess Technical Difficulty of Superciliary Keyhole and Pterional Approaches for Unruptured Middle Cerebral Artery Aneurysms. J Korean Neurosurg Soc. 2016; 59(6):564-569. PMC: 5106354. DOI: 10.3340/jkns.2016.59.6.564. View

Chalouhi N, Thakkar V, Tjoumakaris S, Gonzalez L, Hasan D, Rosenwasser R . Microsurgical clipping of large and giant cerebral aneurysms: a single-center contemporary experience. J Clin Neurosci. 2014; 21(8):1424-7. DOI: 10.1016/j.jocn.2013.11.052. View

10.

Chen L, Tian X, Zhang J, Huang Y, Chen E, Lan Q . Is eyebrow approach suitable for ruptured anterior circulation aneurysms on early stage: a prospective study at a single institute. Acta Neurochir (Wien). 2009; 151(7):781-4. DOI: 10.1007/s00701-009-0205-9. View

11.

van Lindert E, Perneczky A, Fries G, Pierangeli E . The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol. 1998; 49(5):481-9; discussion 489-90. DOI: 10.1016/s0090-3019(96)00539-3. View

12.

Paladino J, Mrak G, Miklic P, Jednacak H, Mihaljevic D . The keyhole concept in aneurysm surgery--a comparative study: keyhole versus standard craniotomy. Minim Invasive Neurosurg. 2005; 48(5):251-8. DOI: 10.1055/s-2005-915599. View

13.

Yu L, Huang Z, Ren Z, Shao J, Zhang Y, Wang R . Supraorbital keyhole versus pterional craniotomies for ruptured anterior communicating artery aneurysms: a propensity score-matched analysis. Neurosurg Rev. 2018; 43(2):547-554. DOI: 10.1007/s10143-018-1053-y. View

14.

Mori K . Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg. 2014; 9(1):14-20. PMC: 4038860. DOI: 10.4103/1793-5482.131059. View

15.

Shin D, Park J . Unruptured Supraclinoid Internal Carotid Artery Aneurysm Surgery : Superciliary Keyhole Approach versus Pterional Approach. J Korean Neurosurg Soc. 2012; 52(4):306-11. PMC: 3488637. DOI: 10.3340/jkns.2012.52.4.306. View

16.

Kim Y, Yoo C, Park C, Kim M, Choi D, Kim Y . Modified Supraorbital Keyhole Approach to Anterior Circulation Aneurysms. J Cerebrovasc Endovasc Neurosurg. 2016; 18(1):5-11. PMC: 4842910. DOI: 10.7461/jcen.2016.18.1.5. View

17.

Caplan J, Papadimitriou K, Yang W, Colby G, Coon A, Olivi A . The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients. Neurosurgery. 2014; 10 Suppl 2:200-6. DOI: 10.1227/NEU.0000000000000348. View

18.

Park J, Woo H, Kang D, Sung J, Kim Y . Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation. Neurosurgery. 2011; 68(2 Suppl Operative):300-9. DOI: 10.1227/NEU.0b013e3182124810. View

19.

Jane J, Park T, Pobereskin L, Winn H, Butler A . The supraorbital approach: technical note. Neurosurgery. 1982; 11(4):537-42. View

20.

Lin Y, Zhang W, Luo Q, Jiang J, Qiu Y . Extracranial microanatomic study of supraorbital keyhole approach. J Craniofac Surg. 2009; 20(1):215-8. DOI: 10.1097/SCS.0b013e318191cf8a. View