LAUSR

BACKGROUND Open cerebrovascular surgery remains an irreplaceable tool in the neurosurgeon's armamentarium for cerebral aneurysms. Among open approaches, the supraorbital keyhole approach provides a novel approach with less soft tissue dissection and cortical exposure compared to the traditional pterional approach. OBJECTIVE To perform a descriptive synthesis of the published literature on cerebral aneurysms approached surgically via the supraorbital keyhole approach. METHODS Following PRISMA guidelines, we performed a systematic literature review of PubMed, Scopus, and Web of Science. Patient demographic data, aneurysm characteristics, Hunt and Hess score, clipping rate, operative time, post-operative neurologic status, length of stay, and follow-up were extracted. We then performed a meta-analysis to obtain pooled estimates of these metrics across studies, including assessments for cross-study heterogeneity and publication bias. RESULTS Under a random effects estimate, mean intraoperative rupture rate was 6.0%. Clipping rate was 99% under a pooled fixed estimate. Significant publication bias was found within studies for aneurysm clipping rate. Forest plot analysis revealed an average clinical outcome of 93% of a modified Rankin score from 0 to 2 or Glasgow Outcome Score of IV to V at post-operative follow-up. CONCLUSIONS Aneurysm treatment is highly heterogeneous within the current literature. The supraorbital keyhole approach is an effective strategy for aneurysm treatment.