title: The modified pterional keyhole craniotomy for open cerebrovascular surgery: a new workhorse?
abstract: BACKGROUND
  The frontotemporal craniotomy is the most commonly used approach for vascular neurosurgery. However, this approach requires significant mobilization of overlying soft tissues, resulting in muscle atrophy and temporomandibular joint pain. We describe a modified pterional keyhole approach and its use in our initial clinical experience.
  
  
  METHODS
  Eleven consecutive minimally invasive pterional keyhole approaches were used for 14 aneurysms. Patient demographics, aneurysm characteristics, and morbidities were prospectively collected.
  
  
  RESULTS
  Mean aneurysm size was 6.5 mm, and all were in the anterior circulation. All aneurysms were successfully clipped, with no occurrence of intraoperative rupture or perforator occlusion. There were no incidences of frontalis nerve injury. No technical difficulties or limitation to aneurysm access were experienced.
  
  
  CONCLUSIONS
  In carefully selected patients, a minimally invasive keyhole approach may be a safe and effective alternative to traditional pterional craniotomy for certain anterior circulation aneurysms.
authors: Department of Neurological Surgery, University of Florida, Gainesville, Florida, United States.
authors: J
authors: J
authors: Mocco
authors: Ricardo J
authors: RJ
authors: Komotar
authors: Daniel M S
authors: DM
authors: Raper
authors: Christopher P
authors: CP
authors: Kellner
authors: E Sander
authors: ES
authors: Connolly
authors: Robert A
authors: RA
authors: Solomon
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000601:surgery*; D020209:Cranial Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010027:Osteotomy; D056888:Patient Positioning; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome