title: A Review of the Literature on the Transciliary Supraorbital Keyhole Approach.
abstract: BACKGROUND
  Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach.
  
  
  METHODS
  We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection.
  
  
  RESULTS
  Eight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable.
  
  
  CONCLUSIONS
  This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Diagnostic and Interventional Neuroradiology Section, Department of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland. Electronic address: daniel.zumofen@usb.ch.
authors.forename: Daniel Walter
authors.initials: DW
authors.lastname: Zumofen
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rychen
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Roethlisberger
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Ethan
authors.initials: E
authors.lastname: Taub
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kalbermatten
authors.affiliation: Division of Neurosurgery, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Potts
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
authors.affiliation: Department of Neurological Surgery, New York University Langone Medical Center, New York, New York, USA.
authors.forename: Howard Antony
authors.initials: HA
authors.lastname: Riina
authors.affiliation: Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods; D003399:Craniotomy / Q000379:methods*; D005138:Eyebrows; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D016896:Treatment Outcome
keywords: Eyebrow skin incision; Minimally invasive neurosurgery, keyhole neurosurgery; Supraorbital craniotomy; Transciliary supraorbital approach