Supraciliary keyhole craniotomy for brain abscess debridement

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Treatments for brain abscesses have typically involved invasive craniotomies followed by debridement. These methods often require large incisions with vast exposure and may be associated with high morbidity rates. For supraorbital lesions of the anterior and middle cranial fossa, minimally invasive craniotomies may limit exposure and decrease surgically related morbidity while allowing adequate debridement and decompression. The authors report their experience in treating frontal epidural abscesses in pediatric patients through minimally invasive supraciliary craniotomies over a 4-year period.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Three pediatric patients with frontal epidural abscesses underwent minimally invasive debridement procedures. Each procedure consisted of a supraciliary incision and a small craniotomy to expose the abscess. All patients underwent pre- and postoperative radiological evaluation including computed tomography and magnetic resonance imaging. Data were collected on preoperative characteristics, operative management, and postoperative outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Two patients were male and 1 patient was female. The ages of the patients ranged from 6 to 10 years (mean 8 years). A frontal abscess was diagnosed in all patients, and all were treated surgically without perioperative complications. Microbes cultured postoperatively included methicillin-resistant <jats:italic>Staphylococcus aureus</jats:italic> in 2 patients and <jats:italic>Staphylococcus viridans</jats:italic> in 1 patient. The mean follow-up duration was 12.3 months. No neurological or vascular complications were noted during follow-up. All patients were treated with antibiotics postoperatively and experienced resolution of symptoms and excellent outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Frontal epidural abscesses can be adequately and safely debrided via a minimally invasive supraciliary craniotomy. This approach has a cosmetic benefit and may decrease approach-related morbidity.</jats:p></jats:sec>

Cosmetic Outcomes of Supraorbital Keyhole Craniotomy Via Eyebrow Incision: A Systematic Review and Meta-Analysis

“…This review yielded 124 studies that were eligible, all of which were included in the qualitative and quantitative synthesis as well as risk of bias appraisal. 3 4 7 8 9 10 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88…”

Supraorbital eyebrow approach: A single-center experience

“…Noggle et al as well as Hallak et al each reported three cases of frontal epidural empyema in pediatric patients who were evacuated through the SOE approach. [6,12] Our case series too included three cases of frontal epidural empyema secondary to complicated paranasal sinusitis which were adequately and safely debrided through the minimally invasive SOE approach.…”

Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes

“…18 With endoscopic assistance, the small working operative window can be further resolved. 57 In this systematic review, nine studies 7,40,41,[43][44][45][46][47][48] reported the use of neuroendoscopy.…”

“…Skin incisions were made superior to the eyebrow in six studies. 33,34,[41][42][43][44] A skin incision within the hair of the eyebrow was made in nine studies. 7,39,40,[45][46][47][48][49][50] Endoscopic assistance was reported to be used in all patients in eight studies 7,40,41,[43][44][45][46][47][48] and in 25% (2/8) of cases in one study.…”

“…7,39,40,[45][46][47][48][49][50] Endoscopic assistance was reported to be used in all patients in eight studies 7,40,41,[43][44][45][46][47][48] and in 25% (2/8) of cases in one study. 41 Types of lesions undergoing minimally invasive supraorbital craniotomy include 55 craniopharyngiomas, 7,34,41 nine epidural hematomas, 42 six epidural abscesses, 33,40,42 one metastatic medulloblastoma, 42 one medulloblastoma, 7 one glioblastoma, 42 21 gliomas, 7,33,34 one J o u r n a l P r e -p r o o f frontal encephalocele, 42 33 arachnoid cysts, 34,44,45 eight dermoid tumors, 7,34,39,50 three hypothalamic hamartomas, 7,34 two neurenteric cysts, 7,47 two neuronal tumors, 34 one compound skull fracture, 7 one pituitary macroadenoma, 7 one cavernoma,…”