Transorbital keyhole approach to anterior communicating artery aneurysms

OBJECTIVE: The transorbital keyhole approach to anterior communicating arte ry aneurysms was developed as a minimally invasive method for safe control of the anterior communicating artery complex. This approach does not necess itate resection of the gyrus rectus. METHODS: The technique is described in detail. The transorbital keyhole app roach provides more ventral access than the supraorbital approaches, and th e anterior communicating artery complex can be controlled by splitting the basal aspect of the interhemispheric fissure. RESULTS: Since late 1998, the authors have used the transorbital keyhole ap proach routinely. During the initial experience with 33 patients, the only observed complication specific to this approach was transient diplopia in o ne patient. At follow-up examinations 2 to 15 months after surgery, the cos metic results were favorable as compared with those of standard pterional c raniotomy. CONCLUSION: We have designed a small, custom-tailored approach to the anter ior communicating artery complex for routine use. The small orbitocranial a pproach is a step toward the ideal of purely extra-axial safe control of an terior communicating artery aneurysms. The orbitocranial keyhole approach s eems to be substantially better than the craniotomy, although it requires a dditional effort and time.