Keyhole Approach in Cerebral Aneurysm Surgeries

Pterional approach via standard fronto-temporal craniotomy and interhemispheric approach via bifrontal craniotomy are the gold standards for clipping of cerebral aneurysms in the anterior circulation. Endovascular treatment is now widely used, but subsets of aneurysms are still indicated for surgical clipping. Modern technological advances allow less invasive clipping techniques such as the keyhole approach. This chapter discusses the surgical indications, preoperative simulation, surgical techniques, and pros and cons of keyhole (supraorbital) clipping. Selection of standard craniotomy or keyhole craniotomy should be uncontroversial, but keyhole clipping requires definite surgical indications based on the characteristics of the target aneurysm for safe clipping.