Single surgeon experience with minimally invasive supraorbital craniotomy versus bifrontal craniotomy for anterior skull base meningiomas

Abstract

Background: Anterior skull base meningiomas (ASBMs) account for about 10% of meningiomas. Bifrontal craniotomy (BFC) represents the traditional transcranial approach to accessing meningiomas in these locations. Supraorbital craniotomy (SOC) provides a minimally invasive subfrontal corridor in select patients. Here, we present our series of ASBM accessed by SOC and BFC by a single surgeon to review decision-making and compare outcomes in both techniques. Methods: Thirty-three patients were identified with ASBM. Age, tumor characteristics, presenting symptoms, postoperative complications, and outcomes were analyzed. Results: Bifrontal and SOC were performed in 13 and 20 patients, respectively. Mean follow-up time was 98.4 months. Patients undergoing SOC had smaller tumor size, located farther from the posterior table of frontal sinus, had less peritumoral edema, and decreased length of stay compared to patients undergoing BFC. Extent of resection was slightly better with BFC (99.8%) compared to SOC (91.8%), although this difference did not reach statistical significance. Recurrence-free survival and rate of re-do surgeries were not different between two groups. BFC was associated with higher rates of postoperative encephalomalacia. Conclusion: SOC provides an excellent surgical option for ASBMs providing comparable extent of resection, minimal manipulation of brain, and excellent cosmetic outcomes for patients. The patient selection is key to maximize the benefits from this approach.

Supraorbital eyebrow approach: A single-center experience

“…[17] Seaman et al reported a 91.8% rate of tumor resection for their case series involving 30 anterior skull base meningiomas operated through a supraorbital craniotomy. [18] Within our cerebral aneurysm subgroup, 100% clip ligation occlusion was achieved without any acute perioperative complications. All deaths in the aneurysm subgroup were in patients who presented with WFNS subarachnoid haemorrhage grades of ≥ III and the mortalities were a result of complications of SAH.…”

“…Several other authors have reported similar findings of relatively shorter ICU and overall hospital stay. [3,4,7,18] Seaman et al found that the SOE approach was associated with decreased operative time (average of 1-h shorter) and length of hospital stay (4-day shorter) compared to the traditional bifrontal craniotomy for anterior skull base meningiomas. [18] Fonseca et al in their comparative series of anterior aneurysms reported a shorter ICU stay of 1.65 days for patients treated through the supraorbital craniotomy compared to 4.54 days for those treated through a pterional craniotomy.…”

“…[3,4,7,18] Seaman et al found that the SOE approach was associated with decreased operative time (average of 1-h shorter) and length of hospital stay (4-day shorter) compared to the traditional bifrontal craniotomy for anterior skull base meningiomas. [18] Fonseca et al in their comparative series of anterior aneurysms reported a shorter ICU stay of 1.65 days for patients treated through the supraorbital craniotomy compared to 4.54 days for those treated through a pterional craniotomy. [3] ese considerations are important as shortened procedure time and length of hospital stay translates to a decrease in resource consumption and maximizes efficiency.…”

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

“…(1) Several problems emerged when removing large tumors through a small keyhole, including the small operation space and limited visual field, especially deep anterior skull base lesions. 29 Therefore, this approach is not suggested for tumors with abundant blood supply, hard texture, and a wide range of involvement. And based on the cases we met, it is also not suitable for giant invasive pituitary adenomas, which had tight wrapping around the internal carotid artery and recurrent craniopharyngiomas, which may adhere tightly to the hypothalamus and the third ventricle floor, under these circumstances, it may be very difficult to achieve gross-total resection.…”

The Effect of Giving a Hot Pack to Grade Shivering in Post-Operative Patients Following a Cesarian Section in the Recovery Room

“…Surgical actions can cause various problems. One of the complications that may arise after surgery is a decrease in the client's body temperature or postoperative hypothermia (1). The process of decreasing body temperature due to surgery will increase the body excess, improve vasoconstriction, and cause changes in the system of thermoregulation in the hypothalamus.…”