Supraorbital Keyhole Approach for Anterior Circulation Aneurysms: An Institutional Experience

  • Narendra Singh Rajasthan, India
  • Manish Agrawal Rajasthan, India,
  • Surendra Jain Jaipur, Rajasthan, India
  • Jasdeep Singh Khanuja Rajasthan, India
  • Shashi Kant Jain Rajasthan, India
Keywords: Anterior circulation aneurysm, Minimal invasive approach, Pterional craniotomy, Supraorbital keyhole surgery


Background: Pterional approach is most accepted and most common approach for clipping of intracranial anterior circulation aneurysms. This approach imparts good exposure of anterior and middle skull base. However the Pterional approach has potential adverse effects, such as long operative time, excessive blood loss, long hospital stay, and temporal muscle atrophy. Supraorbital keyhole via eyebrow incision is a minimal invasive approach for anterior circulation aneurysm surgery. This approach has advantages of less operative time, less blood loss, less brain retraction, short hospital stay and no temporal muscle atrophy.
Objective: Objective of this study to emphasize the advantages and limitations of supra orbital key hole approach for anterior circulation aneurysm surgery based on our institutional experience.
Material and Methods: Between September 2017 and February 2020, total 16 patients with anterior circulation aneurysms were operated by suprorbital keyhole craniotomy approach. All patients included were ≥18 years of age with Subarachnoid hemorrhage grade 1, grade 2, grade 3 on modified fischer scale. Intra operative and postoperative parameter noted and analyzed over a period of 3 months follow up.
Results: There were good cosmetic results with less approach related complications. We achieved good recovery (4/5) on Glasgow outcome scale score 4 or 5 were achieved in 87.5% of the patients in follow period of 3 months.
Conclusion: Supra orbital key hole approach is not a standard approach for all kind of anterior circulation aneurysms, it can be applied for small sized aneurysms with SAH grade up to 3 on modified fischer scale. An thorough pre-op work up, experience, skilled hand are prerequisites for supra orbital keyhole approach in aneurysm surgery. Selection of this approach should be based on aneurysms morphology, size of aneurysm, grade of SAH, brain edema, and the surgeon’s experience.

Author Biographies

Narendra Singh, Rajasthan, India

1Resident, Department of Neurosurgery, Swai Man Singh Medical College, Jaipur, 

Manish Agrawal, Rajasthan, India,

2Professor, Department of Neurosurgery, Swai Man Singh Medical College, Jaipur, 

Surendra Jain, Jaipur, Rajasthan, India

3Assistant Professor, Department of Neurosurgery, Swai Man Singh Medical College,

Jasdeep Singh Khanuja, Rajasthan, India

1Resident, Department of Neurosurgery, Swai Man Singh Medical College, Jaipur, 

Shashi Kant Jain, Rajasthan, India

4Professor and Head, Department of Neurosurgery, Swai Man Singh Medical College, Jaipur, 


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