Resection of Tumors Located in the Anterior Skull Base and Sellar Region Through the Supraorbital Keyhole Approach via a Forehead Wrinkle Incision: Modifications and Deficiencies

Abstract

Objective: To investigate the clinical effect of the supraorbital keyhole approach (SKA) via a forehead wrinkle incision in the resection of tumors in the anterior skull base and sellar region. Methods: Sixty patients with tumors located in the anterior skull base and sellar region treated through the SKA in our hospital from 2017 to 2020. The skin incision and bone flap position were designed individually according to the size and growth of the tumor. The clinical data of the patients were retrospectively analyzed. Results: Based on the feasibility of this surgical approach, personalized skin incisions and bone flaps were designed for different lesions. Among the 60 patients, gross total resection was achieved in 53 cases (88.3%), for meningiomas 97.8% (46/47) and near-total resection in 7 cases (11.7%). In the survey of the patients’ scale scores toward skin incision after operation, the “no pain” level was 90.0% (54/60) and 91.7% (55/60) for the level of “very satisfactory” of the aesthetic of the skin incision (as shown in Supplementary Digital Content, Table 2, http://links.lww.com/ SCS/D742). Three patients whose satisfaction with the aesthetic of the incision excelled scale 3, suggesting that they were not completely satisfied with the wound healing. No permanent skin incision discomfort was noted during follow-up. There were no surgical deaths. Conclusions: The SKA via forehead wrinkle incision is a flexible and feasible method for tumors near the midline of the anterior skull base and sellar region. However, this approach requires strict preoperative planning, which includes choosing appropriate tumors and applicable forehead wrinkles.