Transpalpebral Orbitofrontal Craniotomy: A Minimally Invasive Approach to Anterior Cranial Vault Lesions

ABSTRACT

To describe a minimally invasive approach to anterior cranial vault pathology using a transpalpebral exposure with a miniorbitofrontal craniotomy. Design: Case series. Setting: Tertiary referral hospital with multidisciplinary skull base program. Participants include patients with intra-axial and extra-axial anterior skull base lesions who underwent the transpalpebral minicraniotomy approach. Main Outcome measures: Feasibility of the approach to permit adequate exposure of targeted lesion. We applied this approach in seven patients for the repair of persistent cerebrospinal fluid leaks, pneumocephalus, and the biopsy or resection of midline brain tumors along the anterior cranial base. The approach allowed bimanual instrumentation working with either endoscopic or microscopic visualization for tumor resection and repair of dural and cranial base defects. We measured an average working distance of 4 cm to the sella. The transpalpebral miniorbitofrontal craniotomy approach to the anterior cranial base is quick, adequate, and safe and should be considered as an alternative to extended bifrontal approaches and/or pterional craniotomies for select anterior cranial vault pathology.

KEYWORDS

Eyelid - palpebral - minimally invasive - anterior skull base approach

REFERENCES

• 1 Horsely V. Remarks on the surgery of the central nervous system.  BMJ. 1890;  2 1286-1292
• 2 Krause F. Hirnchirurgie.  Deutsche Lin. 1905;  8 953-1042
• 3 Dandy W. A new hypophysis operation.  Bull Johns Hopkins Hosp. 1918;  29 154-155
• 4 Frazier C H. An approach to the hypophysis through the anterior cranial fossa.  Ann Surg. 1913;  57 145-150
• 5 Heuer G J. The surgical approach and the treatment of tumors and other lesions about the optic chiasm.  Surg Gynecol Obstet. 1931;  53 489-518
• 6 Cushing H. The pituitary body and its disorders: clinical states reduced by disorders of the hypophysis cerebri. Philadelphia, PA; JB Lippincott 1912
• 7 Janecka I P, Sekhar L N. Anterior and anterolateral craniofacial resection. In: Sekhar LN, Janecka IP Surgery of Cranial Base Tumors. New York, NY; Raven Press 1993: 147-156
• 8 Al-Mefty O. Supraorbital-pterional approach to skull base lesions.  Neurosurgery. 1987;  21 474-477
• 9 Raveh J, Laedrach K, Speiser M et al.. The subcranial approach for fronto-orbital and anteroposterior skull-base tumors.  Arch Otolaryngol Head Neck Surg. 1993;  119 385-393
• 10 Zabramski J M, Kiriş T, Sankhla S K, Cabiol J, Spetzler R F. Orbitozygomatic craniotomy. Technical note.  J Neurosurg. 1998;  89 336-341
• 11 Jankowski R, Auque J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
• 12 Jho H D, Ha H G. Endoscopic endonasal skull base surgery: part 1—The midline anterior fossa skull base.  Minim Invasive Neurosurg. 2004;  47 1-8
• 13 Har-El G, Casiano R R. Endoscopic management of anterior skull base tumors.  Otolaryngol Clin North Am. 2005;  38 133-144, ix
• 14 Delashaw Jr J B, Tedeschi H, Rhoton A L. Modified supraorbital craniotomy: technical note.  Neurosurgery. 1992;  30 954-956
• 15 Fernandes Y B, Maitrot D, Kehrli P. Supraorbital minicraniotomy.  Skull Base Surg. 1997;  7 65-68
• 16 Jallo G I, Bognár L. Eyebrow surgery: the supraciliary craniotomy: technical note.  Neurosurgery. 2006;  59(Suppl 1) E157-E158 discussion E157-E158
• 17 Ramos-Zúñiga R. The trans-supraorbital approach.  Minim Invasive Neurosurg. 1999;  42 133-136
• 18 Andaluz N, Romano A, Reddy L V, Zuccarello M. Eyelid approach to the anterior cranial base.  J Neurosurg. 2008;  109 341-346
• 19 Schwartz M S, Anderson G J, Horgan M A, Kellogg J X, McMenomey S O, Delashaw Jr J B. Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach.  J Neurosurg. 1999;  91 1020-1026