The role of pterional keyhole approach in the microsurgical clipping of anterior circulation artery aneurysms: experiences with 26 cases and literature review

Background: Although the pterional approach is commonly used for microsurgical clipping of intracranial aneurysms of anterior circulation, the incision and temporalis muscle dissection impact postoperative recovery and cosmetic outcomes. The pterional keyhole approach offers similar microsurgical corridors with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. The purpose of this study was to report our experience with the minimally invasive pterional keyhole approach in microsurgical clipping of anterior circulation aneurysms. Material and methods: Retrospective analysis was performed in 26 patients with anterior circulation aneurysms that were surgically treated via the pterional keyhole approach between January 2012 and June 2013. Various outcomes were recorded including clinical grade, cosmetic problems, patient satisfaction, and complications such as hyposmia and infection. Digital subtraction angiography (DSA) or computer tomography angiography (CTA) were used in follow-up analyses. Results: Anterior circulation aneurysms in all 26 patients were clipped successfully via the pterional keyhole approach. None of the patients died or experienced severe neurological dysfunction. No facial paralysis occurred due to damage of the facial nerve. DSA and CTA showed that the clipping through pterional keyhole approach was successful. Conclusion: The pterional keyhole approach reduced surgical trauma and complications and promoted recovery relative to surgery requiring a larger incision. This minimally invasive, safe, and effective surgical method approach was used successfully to treat 26 patients with anterior circulation artery aneurysms.