gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

The keyhole concept in aneurysm surgery: Results from the past 22 years

Meeting Abstract

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  • G. Fischer - Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz
  • J. Oertel - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.11.05

doi: 10.3205/11dgnc082, urn:nbn:de:0183-11dgnc0827

Published: April 28, 2011

© 2011 Fischer 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: Improvements in preoperative imaging and intraoperative visualization have led to a refinement in surgical techniques. As a contribution to the ongoing debate on the impact of keyhole approaches in aneurysm surgery, the experience of 22 years with consequent application of keyhole technique is reported as a retrospective single-center study.

Methods: Over a 22-year period, 1082 consecutive patients with 1393 aneurysms were surgically treated in 1146 operations; 693 in the acute stage after SAH and 453 with unruptured aneurysms. Outcome was assessed using the modified Rankin scale as well as approach-related complications.

Results: The majority of cases were treated by four different keyhole approaches: the supraorbital approach was used to treat 1057 aneurysms, the subtemporal for 50 aneurysms, the interhemispheric for 51 aneurysms, the retromastoidal for 59 aneurysms. The classic pterional approach was applied to treat 176 aneurysms. The complication rates of the keyhole approaches were less than in the pterional group, although the difference did not reach a statistical significance.

Conclusions: The overall outcome, the rate of re-treatment and approach-related complications using a keyhole approach for the management of ruptured and unruptured aneurysms are comparable with recently published conventional surgical aneurysm series. In addition to the common benefits of limited exposure approaches, this series demonstrates the appropriate safety and applicability of the keyhole technique in aneurysm surgery as well.