At our practice in Johannesburg, the use of keyhole surgical techniques is at the heart of what we do. Professor Christos Profyris adopted keyhole surgery techniques very early on in his career and undertook further dedicated specialist training in the form of a fellowship under Professor Charles Teo who is a pioneer in the field of Minimally invasive Neurosurgery.


The philosophy for a keyhole craniotomy is such that the skin incision and size of the bone removed (craniotomy) is the smallest possible that is required in order to safely remove a tumour or address a lesion.  The basic steps in performing the craniotomy are similar to those discussed under “Brain Tumour Resection” however, attention is directed to performing a small craniotomy and thereby exposing less brain than what is needed.

Depending on the position and depth of a tumour, many operations are performed through skin incisions of 5 centimetres or less. Technologies such as the neurosurgical microscope, endoscopy, neuronavigation, tractography (DTI) and ICG all aid in helping keep the craniotomies small and safe.

Keyhole neurosurgery can be done from different positions known as approaches, which depends on the location of the tumour or area in need of surgery. The following are some of the more common approaches that can be used to access various areas of the brain through only a small incision:

  • Supraorbital Eyebrow Approach
  • Endonasal Endoscopic Approach (through the nostrils)
  • Extended Endonasal Approach (through the nostrils)
  • Mini-Pterional Approach
  • Retromastoid Approach (behind the ear)
  • Gravity-Assisted Approaches
  • Brain Port Approach
  • Endoscopic Trans-Ventricular Approach

After careful consideration of your brain tumour by Professor Christos Profyris and his team in Gauteng, the appropriate keyhole approach will be selected.  Professor Profyris is experienced in removing tumours such as meningioma, low grade glioma, astrocytoma, glioblastoma, acoustic neuroma, pineal region tumour, medulloblastoma, ependymoma and many other types of tumours through these keyhole approaches.


Keyhole surgery techniques have the following advantages:

  • Shaving of very little hair
  • Execution of targeted brain surgery through the smallest possible opening – you benefit from meticulous pre-operative preparation for your case that is required for keyhole surgery
  • Minimal trauma/exposure of the healthy tissues
  • Quicker recovery
  • Shorter hospital stays
  • Superior cosmetic results

The image collage above exemplifes different keyhole approaches utilised by Professor Profyris.

The image collage above exemplifies different intraoperative images from keyhole approaches utilised by Professor Profyris


What is keyhole brain surgery?

Keyhole or minimally invasive brain surgery aims to tailor each incision to each patients tumour. It is a tailor-made incision that is small and has been made to address your specific pathology based on meticulous pre-operative study of your imaging. It allows for an incision that focuses on your tumour and minimally disrupts your brain or surrounding tissue. This leads to less invasiveness, less post-operative pain and quicker recovery. Compared to traditional approaches, keyhole brain tumour surgery usually utilises incision of approximately 4-6cm, which is significantly smaller than traditional approaches which usually lead to incisions of 20-25cm

How long does it take to recover from keyhole brain surgery?

Recovery is highly variable. However, the keyhole techniques that Professor Profyris utilises allow for faster recovery. Most patients are discharged from hospital after very few days and generally recover fairly quickly. Actual recovery will depend on factors such as tumour size and location. Professor Profyris will have a detailed conversation with you about this.

Is keyhole brain surgery painful?

As keyhole brain surgery uses significantly smaller incisions and cutting of the skull than traditional approaches, post-operative pain is significantly less. Most patients only require very simple pain killers.

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