The keyhole concept in aneurysm surgery--a comparative study: keyhole versus standard craniotomy

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Cerebrovascular Surgery

Background:

• Intracranial aneurysms require surgical intervention, with craniotomy being a common approach.
• Minimally invasive keyhole craniotomy presents an alternative to standard larger craniotomies.
• Comparing the efficacy and safety of these two techniques is crucial for patient outcomes.

Observation:

• A study compared keyhole craniotomy (n=482) with standard craniotomy (n=146) for intracranial aneurysms over eight years.
• Both techniques employed standard microsurgical methods with advanced monitoring and endoscopic assistance.
• Specific keyhole approaches were utilized based on aneurysm location, including eyebrow, temporal, subtemporal, and frontoparietal keyholes.

Findings:

• Keyhole craniotomy and standard craniotomy yielded similar surgical outcomes, with excellent or very good results in 82.57% and 79.45% of patients, respectively.
• The mortality rate was lower in the keyhole craniotomy group (0.83%) compared to the standard craniotomy group (2.05%).
• The choice of craniotomy technique was influenced by the surgical team's experience and familiarity with specific approaches.

Implications:

• Minimally invasive keyhole craniotomy is a viable and effective option for treating various intracranial aneurysms.
• The study supports the recommendation of keyhole craniotomy, particularly in neurovascular surgery.
• Neurosurgical teams can achieve comparable results with either technique, emphasizing the importance of surgeon expertise.