BACKGROUND: Keyhole craniotomy is a type of pterional craniotomy that involves a minimally invasive approach for the treatment of cerebral aneurysms. Currently, the minipterional keyhole craniotomy and supraorbital keyhole craniotomy procedures are frequently performed. METHODS: We evaluated the feasibility and safety of supraorbital keyhole craniotomies and minipterional keyhole craniotomy for the clipping of ruptured intracranial aneurysms in the anterior cerebral circulation as an alternative to the pterional approach in a consecutive series of 25 patients. RESULTS: The rate of intraoperative aneurysmal rupture was 8% (2/25), and all ruptures were safely controlled. CONCLUSION: The success solely depends on careful selection of patients and the experience of the surgical team.