Objective: The pterional approach is the most common approach in vascular neurosurgery, but in recent years has been an increasing interest in minimally invasive surgery or keyhole surgery. We present preliminary results from the use of pterional keyhole approach in surgery for cerebral aneurysms performed in the Cayetano Heredia Hospital in 2009.

Patients and Methods: We performed a pterional keyhole craniotomy of 2.5 x 3 cm from a curved incision of approximately 5-6 cm behind the hairline and centered on the orbitofrontal and posterior aneurysm clipping, in patients with late aneurysms, CoP, bifurcation ICA and MCA aneurysms, Hunt and Hess I-III, without edema, associated vasospasm or hematoma.

Results: From January to December 2009 six patients were operated by pterional keyhole approach, 4 with CoP aneurysms (66%), 1 with ACI (17%) and 1 with ACM (17%). All were operated on late and Hunt and Hess was I in 3 cases (50%) III in 2 cases (33%) and II (17%). There were no operative complications and the outcome was favorable in most cases: Rankin 1 (50%) and Rankin 2 (33%).

Conclusions: The pterional keyhole approach is a minimally invasive surgery for brain aneurysms, which maintains the advantages of the standard pterional approach but it minimizes the exposure of brain parenchyma and soft tissue manipulation. It is a valid surgical alternative in selected cases, mainly from CoP and MCA aneurysms.

      Key Words:  Pterional approach, craniotomy, aneurysms, minimally invasive.