title: Transorbital keyhole approach to anterior communicating artery aneurysms.
abstract: OBJECTIVE
  The transorbital keyhole approach to anterior communicating artery aneurysms was developed as a minimally invasive method for safe control of the anterior communicating artery complex. This approach does not necessitate resection of the gyrus rectus.
  
  
  METHODS
  The technique is described in detail. The transorbital keyhole approach provides more ventral access than the supraorbital approaches, and the anterior communicating artery complex can be controlled by splitting the basal aspect of the interhemispheric fissure.
  
  
  RESULTS
  Since late 1998, the authors have used the transorbital keyhole approach routinely. During the initial experience with 33 patients, the only observed complication specific to this approach was transient diplopia in one patient. At follow-up examinations 2 to 15 months after surgery, the cosmetic results were favorable as compared with those of standard pterional craniotomy.
  
  
  CONCLUSIONS
  We have designed a small, custom-tailored approach to the anterior communicating artery complex for routine use. The small orbitocranial approach is a step toward the ideal of purely extra-axial safe control of anterior communicating artery aneurysms. The orbitocranial keyhole approach seems to be substantially better than the craniotomy, although it requires additional effort and time.
authors.affiliation: Department of Neurosurgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany. hsteiger@nc.med.uni-muenchen.de
authors.forename: H J
authors.initials: HJ
authors.lastname: Steiger
authors.forename: R
authors.initials: R
authors.lastname: Schmid-Elsaesser
authors.forename: W
authors.initials: W
authors.lastname: Stummer
authors.forename: E
authors.initials: E
authors.lastname: Uhl
mesh_terms: D004954:Esthetics; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures; D016896:Treatment Outcome