Comparative Analysis of Supra-Orbital Keyhole Approach and Pterional Approach for Surgical Clipping of Intracranial Anterior circulation Aneurysms in Patients with Favorable Hunt and Hess Grades

Introduction Traditional large craniotomies have been the standard for aneurysm surgery. However, minimally invasive “keyhole” approaches have gained popularity for aneurysm clipping in recent years. This study focuses on Supra-Orbital Keyhole Approach (SOKHA),its use in clipping of aneurysms of the anterior Circle of Willis. Here we share the experiences of a tertiary care center regarding aneurysm clipping using SOKHA. Materials and Methods We retrospectively reviewed 166 cases involving aneurysm clipping, with 62 patients undergoing SOKHA and 104 patients undergoing the pterional approach. Factors evaluated included patient demographics, aneurysm characteristics, incidence of intraoperative complications, temporary-clipping usage, and postoperative clinical outcomes. Glasgow Outcome Scale scores were utilized to assess clinical outcomes. Results The study found that both the SOKHA and pterional approaches were similar in terms of age distribution, Hunt and Hess grades, and the incidence of hydrocephalus. The majority of aneurysms in both groups were anterior communicating artery aneurysms.Hydrocephalus was observed in 14.5% of SOKHA cases and 13.5% of pterional cases. Intraoperative aneurysm rupture occurred in 8.1% of SOKHA cases and 7.7% of pterional cases. There were no mortalities in the SOKHA group, while the pterional group had 1.92% mortality rate. At the last follow-up, 77.4% of SOKHA cases and 75.9% of pterional cases had a favorable outcome (Glasgow Outcome Scale IV and V), with no significant difference. Conclusion SOKHA offers the advantage of potential cosmetic benefit with neurological outcomes comparable to those of the traditional pterional approach, in properly selected patients.