Pterion approach is widely accepted as a standard method for clipping of A-com artery aneurysm. With progresses of microscopic instruments and surgical techniques, keyhole approach for clipping of anterior circulation aneurysm is becoming popular. Objectives: To evaluate & compare clinical outcome of surgery after lateral supraorbital subfrontal keyhole and Pterional craniotomy for anterior communicating artery aneurysm. Materials & Method: This study is a retrospective review between supraorbital subfrontal keyhole versus pterional craniotomy for the surgical management of anterior communicating artery aneurysm in 26 patients operated between jan 2014 and jan 2018 in our institute. Results: A total of 26 were operated for A-com aneurysm, 13 patients by lateral supraorbital keyhole 6 (46.15%) male and 7 (53.84%) female and 13 patient by pterional approach 5 (38.46%) male and 8 (61.53%) females. Compared with the pterional approach, keyhole approach showed better outcomes regarding the incidence of craniotomy-related pain, cosmetic look, and patient satisfaction. Conclusion: In our study there was significantly less amount of blood loss, post operative pain, duration of stay and complications in key hole approach. Eyebrow-lateral supraorbital keyhole approach for microsurgical clipping of A-com artery aneurysm gives satisfactory therapeutic outcomes. 

Keywords: keyhole surgery; A-com aneurysm; supraorbital keyhole.