Fronto-Orbital Variant of Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms (f-Sokha).

Objective: The following paper describes the technique and outcomes of fronto-orbital variant of supraorbital key hole approach (f-SOKHA) to clip anterior circulation aneurysms and compares the same with a similar cohort operated through pterional craniotomy (PT).

Material And Methods: Ambispective study (2012-2019); Technique applied for anterior circulation aneurysms. Contraindications included: Large hematomas, tense brain, avoided in poor grade (Hunt and Hess grade III and IV). Large frontal sinus: Relative contraindication. Procedure included a trans-ciliary skin incision, burr hole over key point, cutting of orbital roof via the burr hole, and removal of a single small fronto-orbital flap (1). This was followed by drilling of the inner table of the frontal bone (2). Both 1 and 2 resulted in expansion of the operative space by 60%. Results compared with a similar cohort of PT.

Results: n = 75 cases; most commonly used for ACom (anterior communicating: 43) followed by middle cerebral (16), internal cerebral (13), Posterior communicating (6), anterior cerebral (2), and anterior choroidal (1). Mean age: 47.9 ± 14 years; mean Hunt and Hess grade: 1.96 ± 1.35; duration of surgery: 203 ± 45 minutes, mean size of aneurysm: 6.96 ± 3.65 mm. Both blood loss and surgery duration was less (P: 0.099 and <0.001) when compared with a similar cohort with PT. It also demonstrated better cosmetic results and patient satisfaction.

Conclusions: f-SOKHA provided a larger operating corridor (60% more) as compared with the standard supra-orbital key-hole approaches while preserving the same degree of minimally invasive nature and cosmetic results.