Background: 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.
Method: 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.
Conclusion: 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.
Keywords: Aneursysm clipping; Eyebrow skin incision; Keyhole approaches; Mini-invasive technique; Supra-orbital approach.