• Vera Ong, Brian Faung, Nolan J Brown, Chenyi Yang, Ronald Sahyouni, Edwin Ng, John P Sheppard, Nathan A Shlobin, Brian V Lien, and Joshua Loya.
• John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
• World Neurosurg. 2022 Dec 1; 168: 287297.e1287-297.e1.

BackgroundOpen cerebrovascular surgery remains an irreplaceable tool in the neurosurgeon's armamentarium for cerebral aneurysms. Among open approaches, the supraorbital keyhole approach provides a novel approach with less soft tissue dissection and cortical exposure compared with the traditional pterional approach.ObjectiveTo perform a descriptive synthesis of the literature on cerebral aneurysms approached surgically via the supraorbital keyhole approach.MethodsFollowing PRISMA guidelines, we performed a systematic literature review of PubMed, Scopus, and Web of Science. Patient demographic data, aneurysm characteristics, Hunt and Hess score, clipping rate, operative time, postoperative neurologic status, length of stay, and follow-up were extracted. We then performed a meta-analysis to obtain pooled estimates of these metrics across studies, including assessments for cross-study heterogeneity and publication bias.ResultsUnder a random-effects estimate, mean intraoperative rupture rate was 6.0%. Clipping rate was 99% under a pooled fixed estimate. Significant publication bias was found within studies for aneurysm clipping rate. Forest plot analysis showed an average clinical outcome of 93% of a modified Rankin Scale score from 0 to 2 or Glasgow Outcome Scale score of IV or V at postoperative follow-up.ConclusionsAneurysm treatment is highly heterogeneous within the literature. The supraorbital keyhole approach is an effective strategy for aneurysm treatment.Copyright © 2022 Elsevier Inc. All rights reserved.

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