Acta Neurochirurgica

, Volume 160, Issue 6, pp 1155–1158 | Cite as

Supraorbital approach through eyebrow skin incision for aneurysm clipping: how I do it

  • Alessio ChiappiniEmail author
  • Francesco Marchi
  • Michael Reinert
  • Thomas Robert
How I Do it - Vascular Neurosurgery - Aneurysm



Surgery has been in a huge development where the aim is to achieve same or better results with less complication in a less invasive way; these minimal approaches can be applied in a very safe way to aneurysmal neurosurgery.


Images are studied to optimize the patient positioning and the surgical roadmap. After the positioning, the skin incision, craniotomy, and dura incision are performed and intradural lesion is reached. A watertight closure is performed under the microscope.


The keyhole approach requires some adaption from the side of the surgeon and can be performed only in cases envisioned to have no increased risk for the patient.


Keyhole approaches Mini-invasive technique Supra-orbital approach Eyebrow skin incision Aneursysm clipping 

Supplementary material


Video of the clipping of a MCA bifurcation aneurysm by supraorbital approach through eyebrow skin incision. Note: The patients gave us the consent to publish the video in an anonymous way. (MP4 425,378 kb)


  1. 1.
    Benifla M, Merkin V, Rosenthal G, Shoshan Y, Melamed I (2016) Supraciliary keyhole craniotomy for anterior frontal lesions in children. J Clin Neurosci 26:37–41CrossRefPubMedGoogle Scholar
  2. 2.
    Hickmann AK, Gaida BJ, Reisch R (2017) How I do it: the expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa. Acta Neurochir (Wien) 159(5):881–887.
  3. 3.
    Jallo GI, Bognar L (2006) Eyebrow surgery: the supraciliary craniotomy: technical note. Neurosurgery 59:ONSE157–ONSE158 discussion ONSE157–158CrossRefPubMedGoogle Scholar
  4. 4.
    Mori K (2014) Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg 9:14–20CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Poblete T, Jiang X, Komune N, Matsushima K, Rhoton AL Jr (2015) Preservation of the nerves to the frontalis muscle during pterional craniotomy. J Neurosurg 122:1274–1282CrossRefPubMedGoogle Scholar
  6. 6.
    Reisch R, Marcus HJ, Kockro RA, Ulrich NH (2015) The supraorbital keyhole approach: how I do it. Acta Neurochir 157:979–983CrossRefPubMedGoogle Scholar
  7. 7.
    van Lindert E, Perneczky A, Fries G, Pierangeli E (1998) The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 49:481–489; discussion 489-490CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Neurocenter of the Southern SwitzerlandRegional Hospital of LuganoLuganoSwitzerland

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