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Updated: Aug 25, 2025
11:58
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
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Keyhole Approaches Applied to Clipping of Acutely Ruptured Intracerebral Aneurysms-A Technical Note and Case Series
Diapo Gerald Mohale1, Denver Naicker1, Blessing Ndlovu1
1Department of Neurosurgery, Helen Joseph Hospital, Johannesburg, South Africa.
World Neurosurgery
|October 15, 2022
Summary
Keyhole surgical clipping is a viable option for ruptured cerebral aneurysms, offering definitive management with minimal disruption. This study demonstrates good outcomes in 72.5% of patients, supporting its use even in acute rupture cases.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Cerebrovascular Surgery
Background:
- Keyhole techniques in aneurysm surgery offer definitive management with minimal disruption of surrounding tissues.
- While experienced surgeons increasingly use keyhole approaches for unruptured aneurysms, experience with ruptured aneurysms is limited.
Purpose of the Study:
- To explore technical nuances and operative outcomes of keyhole surgical clipping for ruptured cerebral aneurysms.
- To assess the feasibility and efficacy of keyhole approaches in managing ruptured intracranial aneurysms.
Main Methods:
- Retrospective case series of 40 consecutive patients with ruptured aneurysms treated with keyhole clipping.
- Approaches included minipterional, supraorbital, and keyhole interhemispheric.
- Outcomes assessed via modified Rankin Scale and World Federation of Neurological Surgeons grading.
Main Results:
- Minipterional approach used in 55%, supraorbital in 30%, and mini-interhemispheric in 15% of cases.
- Complete aneurysm occlusion achieved in 97.4% of cases, with no conversion to larger craniotomy.
- Good outcomes (mRS ≤2) achieved in 72.5% of patients; 92.9% for WFNS grades I-III.
Conclusions:
- Keyhole approaches are a viable option for clipping ruptured intracranial aneurysms.
- Sound technical execution is crucial for successful outcomes in acute settings.
- This series supports the use of keyhole techniques for definitive management of ruptured aneurysms.
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