Objective To compare the anatomical difference between the pterional and supraorbital keyhole approaches in exposing the anterior communicating artery complex.Methods Ten adult latex-infused cadaver heads were divided into pterional approach group and supraorbital keyhole approach group (a total of 10 heads and 20 sides). Each specimen was dissected using the pterional approach on one side and the supraorbital keyhole approach on the other. The anatomy of anterior communicating artery complex exposure was then compared between the two groups.Results The zygomatic process-ipsilateral anterior clinoid process distance and angle were significantly different between the supraorbital keyhole approach group (6.23±0.25 cm and 34.08±3.15°, respectively) and the pterional approach group (5.03±0.24 cm and 63.49±4.67°, respectively) (P<0.05). The number of complete exposures at A1, ACoA, and A2 segments was significantly lower in the supraorbital keyhole approach group than in the pterional approach group (P<0.05). The incidence of perforating artery tearing and translocation was also lower in the supraorbital keyhole approach group than in the pterional approach group [10.00% (1/10) vs 60.00% (6/10), P<0.05; 0.00% (0/10) vs 50.00% (5/10), P<0.05].Conclusions While the pterional approach provides greater exposure and wider operational space, the supraorbital keyhole approach, despite its smaller exposure area, is safer and less invasive.