The supraorbital eyebrow approach for removal of craniopharyngioma in children: a case series

Abstract

The supraorbital eyebrow approach is an alternative route to operate on craniopharyngiomas in properly selected cases of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.

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

“…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,…”

“…Rates of gross total resection (GTR) and subtotal resection (STR) rates were reported in four studies 7,34,41,42 and summarized in Table 4. A total of 55 patients were reported to undergo GTR and 22 patients underwent STR.…”

“…34 Four studies reported that scarring was barely visible after six weeks. 7,41,49,50 One study described that the scar was not visible and hidden in the eyebrow. 42 Cosmesis complications were noticed in five studies.…”

“…42 Cosmesis complications were noticed in five studies. 7,39,41,42,47 Two studies reported bone defects on/over the forehead in a total of five patient cases, 7,41 and one study had a case of a split eyebrow. 42 One study reported ptosis found in one J o u r n a l P r e -p r o o f patient, 39 and another study had one patient with postoperative complete third nerve palsy that persisted at one year follow up likely unrelated to approach.…”