title: The supraorbital endoscopic approach for aneurysms.
abstract: OBJECTIVE
  To review our surgical experience in minimally invasive transcranial endoscope-assisted microsurgical treatment of intracranial aneurysms, using the supraorbital keyhole craniotomy.
  
  
  METHODS
  The supraorbital keyhole approach was performed through an eyebrow skin incision in 793 cases for treatment of 989 intracranial aneurysms. Of patients, 474 were operated on after subarachnoid hemorrhage, and 319 were operated on under elective conditions. After lateral frontobasal burr hole trephination, a limited subfrontal craniotomy was created. To achieve adequate intraoperative exposure through the limited approach, endoscopes were used routinely. Surgical outcome was assessed using the modified Rankin scale.
  
  
  RESULTS
  The transcranial endoscope-assisted microneurosurgery technique was used routinely via a supraorbital approach. In 152 operations (19.1%), the endoscope provided important visual information in the vicinity of the aneurysm, revealing subsequent clip repositioning. The results of incidental aneurysms were excellent with a modified Rankin scale score ≤2 in 96.52%. The overall outcome of ruptured aneurysms was good with a modified Rankin scale score ≤2 in 72.2% of patients. There were no approach-related intraoperative or postoperative complications.
  
  
  CONCLUSIONS
  The minimally invasive supraorbital keyhole approach allowed safe surgical treatment of intracranial aneurysms, including after subarachnoid hemorrhage. The markedly improved endoscopic visualization increased the assessment of clip placement with ideal control of surrounding vessels including perforators for identification of incorrect clip position.
authors.affiliation: Centre for Endoscopic and Minimally Invasive Neurosurgery, Zurich, Switzerland. Electronic address: robert.reisch@hirslanden.ch.
authors.forename: Robert
authors.initials: R
authors.lastname: Reisch
authors.affiliation: Department of Neurosurgery, Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Neurosurgery, University of Saarland, Homburg, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Fischer
authors.affiliation: Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Stadie
authors.affiliation: Centre for Endoscopic and Minimally Invasive Neurosurgery, Zurich, Switzerland.
authors.forename: Ralf
authors.initials: R
authors.lastname: Kockro
authors.affiliation: Centre for Endoscopic and Minimally Invasive Neurosurgery, Zurich, Switzerland.
authors.forename: Evaldas
authors.initials: E
authors.lastname: Cesnulis
authors.affiliation: Department of Neurosurgery, Katharinenhospital, Stuttgart, Germany.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Hopf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D044582:Neuroendoscopes; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Intracranial aneurysms; Keyhole neurosurgery; Minimally invasive neurosurgery; Supraorbital craniotomy; Transcranial endoscope-assisted microneurosurgery