• Xiaohua Wu, Sheng Zhang, Zhonghao Cheng, Tin Tun Aung, Yuanjian Fang, and Chenguang Li.
• Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
• World Neurosurg. 2019 Jan 1; 121: e596-e604.

ObjectiveKeyhole craniotomy is a minimally invasive approach for the treatment of middle cerebral artery (MCA) aneurysms. The aim of this study was to compare the clinical outcome between supraorbital keyhole approach and pterional keyhole approach (PKA) in Chinese patients with MCA aneurysm.MethodsConsecutive patients with MCA aneurysms were reviewed between January 2013 and December 2017. Efficacy and safety between PKA and supraorbital keyhole approach were compared. Poor outcome was defined as modified Rankin Scale score of 3-6 at discharge.ResultsThis study enrolled 260 patients; 222 (85.4%) had ruptured aneurysm, and 183 (70.4%) received PKA. The distribution of PKA in unruptured and ruptured aneurysms showed no significant difference (P > 0.05). In subgroup analyses, PKA was more likely associated with poor outcome at discharge in patients with unruptured aneurysms (odds ratio = 5.500, 95% confidence interval = 1.013-29.850, P = 0.048), whereas approach selection was not an independent factor predicting poor outcome in patients with ruptured aneurysms (P > 0.05).ConclusionsIn a Chinese population, supraorbital keyhole approach was superior to PKA in improving outcome in patients with unruptured MCA aneurysms, but the 2 approaches showed comparable outcomes at discharge in patients with ruptured aneurysms.Copyright © 2018 Elsevier Inc. All rights reserved.

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