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However, no large case series have been published on the use of fully endoscopic-assisted minimally invasive keyhole craniotomy for clipping intracranial aneurysms (IAs). To evaluate the value of fully endoscopic-assisted minimally invasive keyhole craniotomy in the treatment of anterior circulation aneurysms. A retrospective analysis was conducted on 20 patients who underwent fully endoscopic-assisted minimally keyhole invasive craniotomy for clipping of IAs. A total of 9 anterior communicating artery (ACoA) aneurysms were clipped using the supraorbital keyhole approach (SKA). Additionally, 10 middle cerebral artery aneurysms (MCA) and 2 posterior communicating artery (PCoA) aneurysms were clipped using the pterional keyhole approach (PKA). The clipping success rate was 100% in all patients. Apart from one patient who experienced transient third cranial nerve palsy, one who developed an intracranial infection, and one who had a brief seizure, no other patients experienced serious complications. Except for one patient who had residual muscle weakness due to a preoperative basal ganglia hemorrhage, all other patients had a modified Rankin Scale (mRS) score of \u2264 1. Fully endoscopic-assisted minimally invasive keyhole craniotomy has promising applications in the treatment of anterior circulation aneurysms in Hunt-Hess grade 0-II, especially for unruptured aneurysms. Future multi-center studies are needed to confirm its broader applicability.<\/jats:p>","DOI":"10.1007\/s10143-025-03226-5","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T02:59:11Z","timestamp":1741402751000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clipping of anterior circulation aneurysms using fully endoscopic-assisted minimally invasive keyhole craniotomy: a clinical study and analysis"],"prefix":"10.1007","volume":"48","author":[{"given":"Huadong","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengyuan","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongqi","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xialin","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchun","family":"Shang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiquan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,8]]},"reference":[{"key":"3226_CR1","doi-asserted-by":"publisher","unstructured":"Etminan N, Rinkel GJ (2016) Unruptured intracranial aneurysms: development, rupture and preventive management. 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The confdentiality of patient data was protected in accordance with the tenets of the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"288"}}