title: Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms.
abstract: Keyhole surgery is partly replacing the standard pterional approach in patients undergoing surgery to treat aneurysms of the anterior circulation. We describe the pterional keyhole approach for the clipping of anterior circulation aneurysms and discuss the efficacy and safety of our keyhole craniotomy procedure. We treated 103 patients with 111 intracranial aneurysms by surgical clipping via the pterional keyhole approach and retrospectively compared the characteristics and clinical outcomes of the keyhole procedure and the standard pterional approach. We also compared the surgical results of the keyhole approach when the operator was an experienced neurosurgeon or a less experienced neurosurgeon guided by an experienced colleague. All keyhole operations were carried out successfully without enlargement of the craniotomy or a change to a different approach. The outcomes of the keyhole and the standard pterional approach in patients with subarachnoid hemorrhage were not significantly different. Favorable outcomes were obtained in patients with unruptured aneurysms treated by either experienced or less experienced surgeons. The pterional keyhole approach offers the same surgical possibilities as conventional pterional approaches for the treatment of anterior circulation aneurysms. It is safe and simple and yields favorable outcomes even if the operators are less experienced neurosurgeons. Careful patient selection and sufficient opening of the sylvian fissure are the key points for good outcomes and the prevention of intraoperative complications.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamahata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokimura
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Tajitsu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Ayumi
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirabaru
authors.forename: Kenji
authors.initials: K
authors.lastname: Takayama
authors.forename: Tomomi
authors.initials: T
authors.lastname: Shinsato
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hirayama
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D002533:Cerebral Angiography; D003399:Craniotomy; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome