A Review of the Literature on the Transciliary Supraorbital Keyhole Approach

Daniel Walter Zumofen*, Jonathan Rychen, Michel Roethlisberger, Ethan Taub, Daniel Kalbermatten, Erez Nossek, Matthew Potts, Raphael Guzman, Howard Antony Riina, Luigi Mariani

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

41 Scopus citations


Background Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach. Methods We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection. Results Eight publications met the eligibility criteria. All publications were of the retrospective case–series or case–cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable. Conclusions This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.

Original languageEnglish (US)
Pages (from-to)614-624
Number of pages11
JournalWorld neurosurgery
StatePublished - Feb 1 2017


  • Eyebrow skin incision
  • Minimally invasive neurosurgery, keyhole neurosurgery
  • Supraorbital craniotomy
  • Transciliary supraorbital approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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