gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Transorbital keyhole approach in aneurysm surgery: a follow-up analysis of approach-related morbidity and cosmetical results

Meeting Abstract

  • D. Hänggi - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
  • S. Lodes - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.04-02

doi: 10.3205/09dgnc128, urn:nbn:de:0183-09dgnc1281

Published: May 20, 2009

© 2009 Hänggi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The transorbital keyhole approach to anterior communicating artery aneurysms was recently introduced as a step toward the ideal of purely extra-axial and safe approach. The goal of the present study was to determine the approach-related morbidity of this skull-base technique and the cosmetical results in the follow-up period.

Methods: In a retrospective design, 74 patients (39 female, 35 male) between January 2004 and June 2008 were integrated in the present analysis. In this patient population the transorbital keyhole approach was performed for anterior communicating artery aneurysms in 69 cases, moreover the approach was used for arteriovenous malformations (2 cases), one cavernous haemangioma, one craniopharyngeoma and one epidermoid. In all patients, the early morbidity classified in complication and approach-related reoperation was documented. Furthermore a clinical examination in the follow-up course after at minimum 6 month after surgery was performed.

Results: The documented early morbidity contained a hyposphagma due orbital venous congestion that was conservatively treatable in 3 cases. In 2 patients facial nerve palsy was seen and 1 patient suffered from ptosis. An approach-related reoperation was necessary in 3 cases. In 2 patients, the reoperation was performed due to a cerebrospinal fluid leak whereas 1 patient suffered from an intraorbital haematoma. In the clinical follow-up course no additional approach-related neurological deficit was observed. Furthermore the patient interview revealed in 86% of the cases the cosmetical status satisfied whereas 14% of the patients were cosmetically unsatisfied due to predominantly atrophy of the temporal muscle.

Conclusions: The transorbital keyhole approach demonstrated low morbidity and satisfying cosmetical results in comparison to other skull base approaches. Therefore, the results of the present analysis underline the recommendation of this extra-axial approach to the anterior communicating artery complex.