Supraorbital Keyhole Approach to the Skull Base: Evaluation of Complications Related to CSF Fistulas and Opened Frontal Sinus

Abstract

Inadvertent opening of the FS during the supraorbital craniotomy is a common surgery-related morbidity; however, the risk for the patient to develop a potentially dangerous meningitis was found to be minimal.

The Endoscopic-Assisted Supraorbital Approach for Resection of Anterior Skull Base Meningiomas: A Large Single-Center Retrospective Surgical Study

“…In line with previous reports, our results firmly support the evidence that the supraorbital eyebrow craniotomy can be safely applied for resection of carefully selected ASBMs. 7,[9][10][11]13,14,[20][21][22][23][24][25][26] In our cohort, complete tumor resection was achieved in 91% of the patients, a data that corresponds to the 63 to 100% published for more extensive approaches (unilateral subfrontal, bifrontal, frontolateral, pterional, and orbitozygomatic). 9,11,13,[27][28][29][30][31][32][33][34] Rates obtained by extended transnasal transsphenoidal surgery are somehow lower, ranging from 57 to 90%, with 90% reached in two very small case series of 3 to 12 carefully selected patients only.…”

“…Our data corresponds to literature rates of 2.3 to 19% CSF fistulas following resection of ASBM through transcranial approaches and 1 to 9.1% following supraorbital approaches. 2,5,6,9,14,23,24,26,29,31,55 The occurrence of this complication constitutes, however, one of the main dilemmas when considering the other minimally invasive surgical strategy for midline ASBMs, namely the transnasal endoscopic approach. The rate of CSF fistula for transnasal endoscopic surgery of the anterior skull base, averaging 8.9%, has been reported to be increased up to 19 or even 25% after meningioma resections, especially in tumors arising from the tuberculum sellae and OG.…”

The use of platelet gel for repair of a cerebrospinal fluid fistula of the skull base (a case report and literature review)

“…В работе F. Thaher и соавт. [9] назальная ликворея после супраорбитального доступа встречалась в 2,3% наблюдений, при этом менингит развился у 1 пациента (12,5% от общего числа больных с назальной ликворей). По данным R. Komotar и соавт.…”

The trans-eyebrow supraorbital approach for removal of anterior cranial fossa and suprasellar meningiomas

“…В результате обзора данных литературы [18,27,[30][31][32][33][34][35] по супраорбитальному чрезбровному доступу за последние 20 лет было найдено 8 статей, представленных большими сериями публикаций (суммарно 2783 пациента, 2508 аневризм и 577 (19%) опухолей).…”