Suprapraorbital “key-hole” Approach for Surgical Treatment of Middle Cerebral Artery Aneurysms

Objective. To describe details and technical difficulties observed in the use of this access for the treatment of middle cerebral artery aneurysms. Methods. This is a retrospective study including 15 patients with middle cerebral artery aneurysm operated on using this technique (two ruptured aneurysms and 13 incidental aneurysms). We considered age, gender, laterality of the aneurysm, and whether it was ruptured. We evaluated the surgical corridor (surgical field exposure and ease of handling of the surgical instruments), surgery time, complications, functional and cosmetic results. Results. This access provides adequate exposure of the surgical field, but the restricted working angle makes it difficult to dissect the aneurysm and, especially, to place the definitive clip. Conclusion. The restriction of the working angle may compromise the safety of the surgery. It is important to determine the specific indications for this access, particularly in cases of incidental aneurysms.