Individual Planning of Supraorbital Keyhole Approaches for Patients With Intra- And Extracranial Tumors

Abstract

The study objective is to generalize the basic principles of the individual preoperative planning in surgery of extra- and intraaxial brain tumors of the frontal lobe and anterior cranial fossa via eyebrow supraorbital keyhole approach. Materials and methods. In 2014–2018, we treated 40 patients with different tumors (meningiomas, gliomas, metastasis) through an eyebrow supraorbital keyhole craniotomy (in F.I. Inozemtsev City Clinical Hospital, Moscow Healthcare Department). Computed tomography and magnetic resonance imaging with enhancement were performed to evaluate location and size of the tumor, relation to the approach-related anatomical structures (size and location of frontal sinus, pneumatization of the anterior clinoid process, depth of olfactory groove) and individual facial anatomy. Results. Gross total removal of the intraaxial tumors was achieved in 69 %, near-total removal in 31 %. The cranial base meningiomas were removed by Simpson II in 23 (96 %) patients, Simpson III in 1 (2.5 %) patient. A breach of frontal sinus was performed in 2 (5 %) patients. There were no cerebrospinal fluid leakage, infection, hemorrhage, morbidity and mortality. Conclusion. Keyhole surgery for patients with large intracranial tumors requires a thorough preoperative assessment of individual anatomical features, which is necessary to plan an optimal route, reduce the risk of injuries to other structures (not related to the surgical target), as well as the frequency of complications. These principles ensure high efficacy and safety of surgical treatment.