Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision
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Updated: Oct 9, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
1National Institute of Neurosurgery, Budapest, Hungary.
Objective:
The purpose of this study was to evaluate the results of 173 frontolateral keyhole minicraniotomies performed on 155 patients with aneurysms of the anterior or posterior cerebral circulation and for supratentorial tumors.
Methods:
The frontolateral keyhole craniotomy is a modification of the generally used pterional approach. Of the 155 patients studied, 102 harbored saccular arterial aneurysms in the vessels of the anterior or posterior cerebral circulation, and 53 had various tumors in the frontal base, suprasellar, or parasellar region. The operations were carried out through an approximately 2.5- x 3-cm frontolateral miniaturized craniotomy after a skin incision just above the eyebrow.
Results:
Despite the small size of the craniotomy, the exploration allows enough room for intracranial manipulation with maximal protection of the brain and other intracranial structures. The presented series of patients did not have any craniotomy-related complications.
Conclusion:
In our experience, the frontolateral keyhole craniotomy, together with the advent of the modern neuroanesthesia, cerebrospinal fluid drainage, and microsurgical techniques, is a safe approach for an experienced neurosurgeon to use in the treatment of supratentorial aneurysms or tumors of the anterior fossa and sellar regions.
Insights
Frontolateral keyhole craniotomy is a safe and effective minimally invasive surgical approach for treating brain aneurysms and tumors. This technique offers sufficient intracranial access while protecting brain structures, with no reported complications.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
Background:
- Traditional pterional approaches can be extensive.
- Keyhole techniques aim to reduce surgical invasiveness.
Purpose of the Study:
- To evaluate the outcomes of frontolateral keyhole minicraniotomies.
- To assess the safety and efficacy for treating aneurysms and tumors.
Main Methods:
- 173 frontolateral keyhole minicraniotomies were performed on 155 patients.
- The approach is a modification of the pterional technique.
- Operations involved a small (2.5 x 3 cm) craniotomy.
Main Results:
- The small craniotomy provided adequate space for intracranial manipulation.
- Maximal protection of the brain and intracranial structures was achieved.
- No craniotomy-related complications occurred in the series.
Conclusions:
- Frontolateral keyhole craniotomy is a safe approach for experienced neurosurgeons.
- It is effective for treating supratentorial aneurysms and tumors.
- Modern neuroanesthesia and microsurgical techniques enhance safety.
