title: Microsurgical experience with keyhole operations on intracranial aneurysms.
abstract: BACKGROUND
  We report our experience with keyhole approaches as favorable treatments for various intracranial aneurysms including multiple aneurysms and giant aneurysms.
  
  
  METHODS
  According to the different locations of 105 aneurysms harbored in 100 patients, different keyhole approaches were designed elaborately, among which a supraorbital keyhole approach was used in 91 cases, a pterional keyhole approach in 5 cases, a subtemporal keyhole approach in 3 cases, a retromastoid keyhole approach in 2 cases, and a unifrontal interhemispheric keyhole approach in 1 case.
  
  
  RESULTS
  Among those 105 aneurysms, 99 were clipped successfully, including 4 that were resected after clipping. One mini-aneurysm was wrapped. The other aneurysms were trapped, including 1 VA aneurysm, 1 giant ICA aneurysm, 1 giant PCoA aneurysm, and 2 giant aneurysms in the PCAs (P2-P3 segment). Multiple aneurysms in 5 cases were treated in 1 surgical session, including 3 cases via unilateral approaches and 2 cases via bilateral approaches. There were no severe keyhole approach-related complications in this present series.
  
  
  CONCLUSIONS
  The keyhole approaches, based on improvements in diagnostic imaging, advanced surgical instruments, and microsurgical skills, are effective and ideal craniotomy techniques in the hands of experienced neurosurgeons for the treatment of intracranial aneurysms, including multiple and giant aneurysms, in patients without diffuse SAH, severe cerebral vasospasm, and severe brain edema or brain swelling.
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215004, PR China. szlqz@pub.sz.jsinfo.net
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Gong
authors.forename: Dezhi
authors.initials: D
authors.lastname: Kang
authors.forename: Hengzhu
authors.initials: H
authors.lastname: Zhang
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Qian
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.forename: Qiang
authors.initials: Q
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D005138:Eyebrows; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D044583:Neuroendoscopy; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome