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Background  Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon's learning curve. This is a study of a surgeon's transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods  Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with sac

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