Supraorbital Keyhole Approach as Applied to Clipping of Ruptured Intracranial Aneurysms—Lessons from a Resource Limited Setting

This presentation explores the application of keyhole approaches as applied to ruptured intracranials aneurysms, with empasis on technical nuances. The author will present his personal series of ruptured aneurysms treated with a keyhole supraorbital approach. Twenty-nine ACOM aneurysms, 27 PCOM, 7 ICA bifurcation, 2 ophthalmic, and 3 MCA aneurysms were treated through a supraorbital keyhole approach. Fifty-one patients presented as WFNS Grades 1 to 3 and 17 patients presented as WFNS grades 4 to 5. Fourty-six (90%) WFNS 1–3 patients had a good outcome defined as a mRS Score of 2 or less. Six of 17 (35%) WFNS 4–5 patients had a good outcome. Fourty-Four patients were clipped within three days of rupture. All aneurysms within the series, including cases with intraoperative rupture, were succesfully clipped. The author’s personal experiences and nuances of applying keyhole approaches to ruptured intracranial aneurysms will be emphasized. Surgical videos will be presented.

Publication History

Article published online:
07 February 2025