Keyhole clipping surgery (supraorbital keyhole and pterional keyhole)

Abstract

Supraorbital keyhole craniotomy via an eyebrow skin incision (Perneczky method) is an alternative to conventional craniotomy for the treatment of various pathologies including aneurysms. We treated unruptured internal carotid artery aneurysms and anterior communicating artery aneurysms using the Perneczky method. We also developed the pterional keyhole approach to middle cerebral artery aneurysms through an outer canthal skin incision. Forty-four keyhole clipping surgeries (46 aneurysms) were performed in 42 patients. Scalp hair shaving, drainage placement, and anti-convulsant medication were not required. Most patients were discharged on the 2nd or 3rd postoperative day (mean 2.8 ± 0.99 days), except for one patient who suffered hemiparesis due to lacunar infarction. Keyhole clipping surgery is another treatment option for relatively small unruptured anterior circulation aneurysms.