title: Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation.
abstract: BACKGROUND
  Neurovascular surgeons have been trying to find a solution to the problem of surgical invasiveness by applying minimally invasive keyhole approaches.
  
  
  OBJECTIVE
  To evaluate the feasibility and surgical outcomes of a superciliary keyhole approach for unruptured intracranial aneurysms (UIAs) as an alternative to a pterional approach.
  
  
  METHODS
  The authors report on a consecutive series of patients who underwent a superciliary approach for clipping UIAs smaller than 15 mm arising at the supraclinoid internal carotid artery (ICA), A1 segment, anterior communicating artery (ACoA), and M1 segment including the middle cerebral artery (MCA) bifurcation. The data were compared with a historical control group (n = 90) who underwent a pterional approach for UIAs.
  
  
  RESULTS
  A total of 120 aneurysms were successfully clipped in 102 patients with a mean age of 58 years. There was no direct mortality related to the surgery, and only 1 (1.0%) patient developed significant morbidity adversely affecting the Glasgow Outcome Scale score. The superciliary approach demonstrated statistically significant advantages over the pterional approach, including a shorter operative duration (mean, 120 min), no intraoperative blood transfusion, and extremely rare postoperative epidural hemorrhages. In addition, temporalis atrophy was rare and palsy of the frontalis persisting more than 6 months only occurred in 6 patients (5.9%) and was resolved within 2 years. The overall cosmetic outcome was excellent.
  
  
  CONCLUSIONS
  A superciliary approach can be a reasonable alternative to a pterional approach for small (<15 mm) UIAs arising at the supraclinoid ICA, A1, ACoA, and M1 segment including the MCA bifurcation.
authors.affiliation: Department of Neurosurgery, Regional Cardiocerebrovascular Center, Brain Science and Engineering Institute, Kyungpook National University, Daegu, Republic of Korea. jparkneurosurgery@gmail.com
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
authors.forename: Hyunjin
authors.initials: H
authors.lastname: Woo
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Joo-Kyung
authors.initials: JK
authors.lastname: Sung
authors.forename: Yongsun
authors.initials: Y
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D019635:Neurosurgical Procedures; D016896:Treatment Outcome