Epidural abscess treated with a medial supraorbital craniotomy through an incision in the eyebrow

Abstract

<jats:p>✓The authors describe a medial supraorbital craniotomy performed through a medial eyebrow skin incision to approach an epidural abscess located in the medial anterior fossa of the skull. An 8-year-old boy presented with fevers and facial swelling. Imaging demonstrated pansinusitis and an epidural fluid collection adjacent to the frontal sinus. A medial supraorbital craniotomy was performed to access and drain the epidural abscess. The supraorbital nerve laterally and the supratrochlear nerve medially were preserved by incising the frontalis muscle vertically, parallel to the course of the nerves, and dissecting the subperiosteal plane to mobilize the nerves. This approach may be a useful access corridor for other lesions located near the medial anterior fossa.</jats:p>

Stab Wound in the Skull Treated with a Medial Supraorbital Craniotomy Through an Incision in the Eyebrow—a Minimally Invasive Approach

“…Classically, lesions located in the medial region of the anterior cranial fossa and frontal sinus are usually approached through large skin incisions behind the line of implantation of hair associated a bifrontal craniotomy [1,2]. The frontolateral supraorbital craniotomy through eyebrow incision is an elegant alternative and versatile approach for lesions located in the anterior cranial fossa allowing adequate exposure of virtually all tumours in this area [1][2][3][4][5].…”

“…The frontolateral supraorbital craniotomy through eyebrow incision is an elegant alternative and versatile approach for lesions located in the anterior cranial fossa allowing adequate exposure of virtually all tumours in this area [1][2][3][4][5]. However, there are few reports of the usefulness of its variant, the medial supraorbital craniotomy through eyebrow incision [1].…”

“…The main advantages of the medial supraorbital craniotomy regarding frontolateral supraorbital craniotomy are as follows: the absence of manipulation of the temporal muscle, less risk of injury to the frontotemporal branch of the facial nerve by dissecting the frontalis vertically and a more medial view of the anterior structures such as the frontal sinus, olfactory groove and frontal lobe [1].…”

“…However, one can avoid damaging these structures by releasing the supraorbital nerve from its notch and the skin incision has the supratrochlear nerve as medial limit. Studies show that the supratrochlear nerve is 9-15 mm medial to the supraorbital nerve [1,6,7]. In our approach, we use these anatomic parameters to avoid inadvertent injury to these nerves.…”

“…Historically, access to the skull base and frontal sinus was performed through large skin incisions and extensive craniotomies [1,2]. However, the development of microsurgical technique and anatomical knowledge enabled the advent of safe minimally invasive techniques that allow adequate exposure, low morbidity and satisfactory cosmetic result.…”