Supraorbital eyebrow approach to skull base lesions

Abstract

-We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.KEY WORDS: tumor, aneurysm, skull base, minimally invasive, surgical approach.Abordagem supra-orbitária superciliar de lesões da base do crânio RESUMO -Reportamos nossa experiência com o uso de uma minicraniotomia supra-orbitária através do supercílio para tratamento de lesões situadas na fossa anterior, cisterna supra-selar, para-selar e fissura de Sylvius. Uma incisão de 50 mm é realizada no supercílio, seguida de minicraniotomia. Dezesseis pacientes portadores de diferentes lesões foram operados e apresentaram bom resultado pós-operatório e também estético. Concluímos que esse acesso é seguro e útil em casos selecionados PALAVRAS-CHAVE: tumor, aneurisma, base do crânio, abordagem minimamente invasiva, acesso cirúrgico. Usually tumors, aneurysms, and other lesions situated in the anterior or middle cranial fossae are approached by the standard classic pterional craniotomy [1][2][3] . Some other new techniques are also used to approach the orbit, anterior fossa and skull base 4-9 .Recently Perneczky et al. [10][11][12] have developed several supraorbital endoscopic "key-hole" approaches and demonstrated a good visualization of the socalled "suprasellar virtual pyramid". Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor or aneurysm and surrounding structures if compared to traditional techniques. We report our experience with a supraorbital eyebrow approach. We add to the description of our 16 cases some details on important landmarks. These landmarks are useful to preserve the frontotemporal branch of the facial nerve, the supraorbital and supratrochlear nerves in order to prevent cosmetic sequela of this easy and time-sparing procedure.

Supraorbital Keyhole Craniotomy in Surgery of Intra- And Extra-Axial Brain Tumors

“…При крупных (5 см и более) и гигантских опухолях показаны доступы традиционные, в ряде случаев -минимальный орби-тозигоматический [3, 4,16].…”

“…Интраоперационный электрофизиологический мониторинг не использовался, поскольку внутримоз-говые опухоли у большинства больных были справа, hypoesthesia was observed in 3 patients (4 Диагностика и лечение опухолей головы и шеи преимущественно в полюсных отделах, вдали от зоны Брока при левополушарной локализации. Степень резекции менингиом оценивалась по шка-ле Д. Симпсона [15].…”

Tumors of the anterior skull base

“…This approach does not disturb the temporalis muscle, branches of the facial nerve or the superficial temporal artery, which decreases operative exposure time when compared with a typical bifrontal craniotomy or pterional craniotomy [52,55,56]. An eyebrow incision eliminates the need for a hair shave and is easily hidden by the eyebrow, which decreases the psychological impact of surgery.…”

“…An eyebrow incision eliminates the need for a hair shave and is easily hidden by the eyebrow, which decreases the psychological impact of surgery. Complications associated with the supraorbital approach include transient anesthesia over the frontal part of the scalp or transient frontalis muscle palsy [52,53,55,56]. Less common are cerebrospinal fluid leaks and sinus fistula [55].…”

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas

“…The major drawback of the supra-orbital approach is the potential for limited maneuverability given the small bony opening which typically measures 15-20 mm by 25-30 mm [1][2][3][4] . Recently, Brazilian authors have reported their initial experience using this approach to treat intracranial aneurysms and intracranial tumors 9,10 . We have been using the supra-orbital approach for the last 6 years to reach anterior fossa, parasellar tumors and intracranial aneurysms.…”