• Daniel Walter Zumofen, Jonathan Rychen, Michel Roethlisberger, Ethan Taub, Daniel Kalbermatten, Erez Nossek, Matthew Potts, Raphael Guzman, Howard Antony Riina, and Luigi Mariani.
• Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Diagnostic and Interventional Neuroradiology Section, Department of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland. Electronic address: daniel.zumofen@usb.ch.
• World Neurosurg. 2017 Feb 1; 98: 614-624.

BackgroundConventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach.MethodsWe searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection.ResultsEight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable.ConclusionsThis approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.Copyright © 2016 Elsevier Inc. All rights reserved.

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