The comparison of conventional pterional and transciliary keyhole approaches: pro and con

For years, neurosurgical operations have developed. Treatment modalities involving new devices and instruments have been innovated. Another principle of management that has been created and developed is the approach to enter the intracranial structure. Yasargil was credited to the standard and may be the most important approach, pterional or frontotemporal approach. Many modifications of this approach by new neurosurgeons has been created. Until now the concept of minimally invasive neurosurgery has been well accepted. The fundamental tendency to be as minimally invasive as possible with a minimum of iatrogenic traumatization and to achieve a maximum of efficiency in the treatment of a patient has existed since the beginning of surgery. The development of unconventional or "difficult approaches", which is based on increased knowledge of microsurgical anatomy, improved preoperative diagnostic techniques, and well-adapted microsurgical instruments, definitely forms one important aspect of "refinement in microneurosurgical operating". The supraorbital keyhole via the eyebrow incision is one of the minimally invasive approaches. Until now, there are debates between the advantage and disadvantage of this approach. The authors present the comparative approaches between these young and old methods. The pros and cons are listed in detail.