• Jun Sang Park, Hoon Kim, Min Woo Baik, and Ik Seong Park.
• Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
• World Neurosurg. 2018 Mar 1; 111: e386-e394.

BackgroundThe transciliary keyhole approach has been actively employed for unruptured intracranial aneurysms in many institutions, although applying this technique to ruptured aneurysms remains controversial. We investigated risk factors related to poor surgical outcomes in ruptured aneurysms and attempted to clarify the differences between conventional craniotomy and keyhole surgery.MethodsA retrospective review was performed at a single institution of medical records and images from surgeries of 188 patients who underwent keyhole surgery for ruptured anterior circulation aneurysms between July 2007 and February 2015.ResultsThe study included 116 (62%) female and 72 (38%) male patients; age range was 23-86 years. Preoperative clinical grades were good in almost all patients except for a few patients with poor clinical grades. Mean aneurysm size was 5.5 mm, and the most common aneurysm location was the anterior communicating artery (n = 82). Most patients (n = 158; 91.5%) showed good clinical outcomes. Univariate analysis of risk factors associated with poor-grade outcomes after 3 months was performed. Hunt and Hess grade (odds ratio [OR] 13.50, P < 0.0001), World Federation of Neurosurgical Societies scale (OR 7.69, P < 0.0001), aneurysm size (OR 1.21, P = 0.019), and vasospasm (OR 6.43, P = 0.0003) were statistically significant, whereas Fisher grade, skin-to-skin time (operation time), rebleeding, and ventricle puncture were not statistically significant.ConclusionsBecause incidence of poor surgical outcome of keyhole surgery is not different from known conventional craniotomy, this approach is an acceptable treatment option in a good-grade ruptured anterior circulation aneurysm.Copyright © 2017 Elsevier Inc. All rights reserved.

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