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J Neurol Surg A Cent Eur Neurosurg 2021; 82(06): 585-593
DOI: 10.1055/s-0040-1722697
Technical Note

Minimally Invasive Subfrontal Approach: How to Make it Safe and Effective from the Olfactory Groove to the Mesial Temporal Lobe

Pier Paolo Mattogno 
1   Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
Francesco Guerrini
2   Department of Neurosurgery, Neurosurgery Unit, Ospedale Alessandro Manzoni, Lecco, Italy
,
Federico Nicolosi
3   Department of Neurosurgery, Humanitas Research Hospital, Milan, Italy
,
Pierpaolo Panciani
4   Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
,
Alessandro Olivi
1   Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
,
Marco Fontanella
4   Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
,
Giannantonio Spena
2   Department of Neurosurgery, Neurosurgery Unit, Ospedale Alessandro Manzoni, Lecco, Italy
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Abstract

Background Different surgical approaches have been developed to manage lesions of the anterior and middle skull base areas. Frontal, pterional, bifrontal, and fronto-orbito-zygomatic approaches are traditionally used to reach these regions. With advancements in the neurosurgical field, skull opening should be simple and as minimally invasive as possible, tailored on the surgical corridor to the target. The supraorbital approach and the “keyhole” concept have been introduced and popularized by Axel Perneczky starting from 1998 and are now considered a part of everyday practice. The extended possibilities of this surgical route, considering the reachable targets and surgical limits, are described and systematically analyzed, including a description of the salient surgical anatomy, presenting different illustrative cases.

Methods and Results Different illustrative cases are presented and discussed to underline the potentials and limits of the minimally invasive subfrontal approach (MISFA) and the possibilities to tailoring the craniotomy on the basis of the targets: extra-axial lesions with different localizations (anterior roof of the orbit, olfactory groove, tuberculum sellae, medial third of the sphenoid wing, anterior and posterior clinoid process), deeper intra-axial lesions (gyrus rectus, medial temporal lobe-uncus-amygdala-anterior hippocampus), and vascular lesions (anterior communicating aneurysm). Each case has been preoperatively planned considering the anatomical and radiologic features and using virtual simulation software to tailor the best possible corridor to reach the surgical target.

Conclusions The MISFA is a safe multicorridor approach that can be used efficiently to manage lesions of the anterior and middle skull base areas with extremely low approach-related morbidity.

Keywords

minimally invasive subfrontal approach - key hole craniotomy - upsurgeon


Publikationsverlauf

Eingereicht: 06. Juni 2020

Angenommen: 28. Oktober 2020

Artikel online veröffentlicht:
12. August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 2003; 59 (03) 223-227
    CrossrefPubMedGoogle Scholar
  • 2 Fischer G, Stadie A, Reisch R. et al. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery 2011; 68 (1, Suppl Operative): discussion 51 45-51
    CrossrefPubMedGoogle Scholar
  • 3 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005; 57 (4, Suppl): discussion 242–255 242-255
    PubMedGoogle Scholar
  • 4 Spena G, Panciani PP, Nicolosi F, Fontanella M. Minimally invasive subfrontal route for the resection of medial temporal region intrinsic tumors. Acta Neurochir (Wien) 2015; 157 (11) 1971-1974
    CrossrefPubMedGoogle Scholar
  • 5 Tullos HJ, Conner AK, Baker CM. et al. Mini-pterional craniotomy for resection of parasellar meningiomas. World Neurosurg 2018; 117: e637-e644
    CrossrefPubMedGoogle Scholar
  • 6 Ivan ME, Lawton MT. Mini supraorbital approach to inferior frontal lobe cavernous malformations: case series. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (03) 187-191
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Kang HJ, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. Comparative analysis of the mini-pterional and supraorbital keyhole craniotomies for unruptured aneurysms with numeric measurements of their geometric configurations. J Cerebrovasc Endovasc Neurosurg 2013; 15 (01) 5-12
    CrossrefPubMedGoogle Scholar
  • 8 Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg 2013; 2013: 296469
    PubMedGoogle Scholar
  • 9 Noiphithak R, Yindeedej V, Ratanavinitkul W, Duangprasert G, Tantongtip D, Liengudom A. Comparison of minimally invasive and pterional craniotomies for ruptured anterior circulation aneurysms: a propensity score matched analysis. World Neurosurg 2020; 138: e289-e298
    CrossrefPubMedGoogle Scholar
  • 10 Figueiredo EG, Welling LC, Preul MC. et al. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. J Clin Neurosci 2016; 27: 34-39
    CrossrefPubMedGoogle Scholar
  • 11 Yagmurlu K, Safavi-Abbasi S, Belykh E. et al. Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery. J Neurosurg 2017; 127 (03) 646-659
    CrossrefPubMedGoogle Scholar
  • 12 Yamahata H, Tokimura H, Tajitsu K. et al. Efficacy and safety of the pterional keyhole approach for the treatment of anterior circulation aneurysms. Neurosurg Rev 2014; 37 (04) 629-636
    CrossrefPubMedGoogle Scholar
  • 13 Choi YJ, Son W, Park KS, Park J. Intradural procedural time to assess technical difficulty of superciliary keyhole and pterional approaches for unruptured middle cerebral artery aneurysms. J Korean Neurosurg Soc 2016; 59 (06) 564-569
    CrossrefPubMedGoogle Scholar
  • 14 Park J, Woo H, Kang DH, Sung JK, Kim Y. Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation. Neurosurgery 2011; 68 (2, Suppl Operative): discussion 309 300-309
    CrossrefPubMedGoogle Scholar
  • 15 Czirják S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery 2001; 48 (01) 145-149 , discussion 149–150
    PubMedGoogle Scholar
  • 16 van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 1998; 49 (05) 481-489 , discussion 489–490
    CrossrefPubMedGoogle Scholar
  • 17 Cai M, Hou B, Luo L, Zhang B, Guo Y. Trans-eyebrow supraorbital keyhole approach to tuberculum sellae meningiomas: a series of 30 cases with long-term visual outcomes and recurrence rates. J Neurooncol 2019; 142 (03) 545-555
    CrossrefPubMedGoogle Scholar
  • 18 Lin YJ, Chen KT, Lee CC. et al. Anterior skull base tumor resection by transciliary supraorbital keyhole craniotomy: a single institutional experience. World Neurosurg 2018; 111: e863-e870
    CrossrefPubMedGoogle Scholar
  • 19 El Shafei HI. Anterolateral mini fronto-orbito-zygomatic craniotomy via an eyebrow incision in pediatrics: technical notes and evaluation. Pediatr Neurosurg 2011; 47 (04) 248-253
    CrossrefPubMedGoogle Scholar
  • 20 Cai M, Ye Z, Ling C, Zhang B, Hou B. Trans-eyebrow supraorbital keyhole approach in suprasellar and third ventricular craniopharyngioma surgery: the experience of 27 cases and a literature review. J Neurooncol 2019; 141 (02) 363-371
    CrossrefPubMedGoogle Scholar
  • 21 Eroglu U, Shah K, Bozkurt M. et al. Supraorbital keyhole approach: lessons learned from 106 operative cases. World Neurosurg 2019:S1878-8750(19)30060-9
    PubMedGoogle Scholar
  • 22 Khanapure K, Joshi KC, Jagannatha AT. et al. Supraorbital craniotomy for large anterior skull base meningiomas: a technical note. Asian J Neurosurg 2019; 14 (03) 767-772
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Prat R, Galeano I, Evangelista R. et al. Trans-eyebrow supraorbital approach in large suprasellar craniopharyngioma surgery in adults: analysis of optic nerve length and extent of tumor resection. Original article. Acta Neurochir (Wien) 2017; 159 (05) 873-880
    CrossrefPubMedGoogle Scholar
  • 24 Banu MA, Mehta A, Ottenhausen M. et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg 2016; 124 (03) 605-620
    CrossrefPubMedGoogle Scholar
  • 25 Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol 1962; 41: 809-813
    PubMedGoogle Scholar
  • 26 Gazzeri R, Nishiyama Y, Teo C. Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. Neurosurg Focus 2014; 37 (04) E20
    CrossrefPubMedGoogle Scholar
  • 27 Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg 2014; 82 (1–2): e243-e256
    CrossrefPubMedGoogle Scholar
  • 28 Linsler S, Fischer G, Skliarenko V, Stadie A, Oertel J. Endoscopic assisted supraorbital keyhole approach or endoscopic endonasal approach in cases of tuberculum sellae meningioma: which surgical route should be favored?. World Neurosurg 2017; 104: 601-611
    CrossrefPubMedGoogle Scholar
  • 29 Rychen J, Croci D, Roethlisberger M. et al. Minimally invasive alternative approaches to pterional craniotomy: a systematic review of the literature. World Neurosurg 2018; 113: 163-179
    CrossrefPubMedGoogle Scholar
  • 30 Nathal E, Gomez-Amador JL. Anatomic and surgical basis of the sphenoid ridge keyhole approach for cerebral aneurysms. Neurosurgery 2005; 56 (1, Suppl): discussion 178–185 178-185
    CrossrefPubMedGoogle Scholar
  • 31 Figueiredo EG, Deshmukh P, Nakaji P. et al. The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery 2007; 61 (05, Suppl 2): discussion 264–265 256-264
    CrossrefPubMedGoogle Scholar
  • 32 Andaluz N, Romano A, Reddy LV, Zuccarello M. Eyelid approach to the anterior cranial base. J Neurosurg 2008; 109 (02) 341-346
    CrossrefPubMedGoogle Scholar
  • 33 Hernesniemi J, Ishii K, Niemelä M. et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl (Wien) 2005; 94: 17-21
    CrossrefPubMedGoogle Scholar
  • 34 Sabbagh AJ, Bajunaid KM, Alarifi N. et al. Roadmap for developing complex virtual reality simulation scenarios: subpial neurosurgical tumor resection model. World Neurosurg 2020; 139: e220-e229
    CrossrefPubMedGoogle Scholar
  • 35 Barber SR, Jain S, Mooney MA. et al. Combining stereoscopic video and virtual reality simulation to maximize education in lateral skull base surgery. Otolaryngol Head Neck Surg 2020; 162 (06) 922-925
    CrossrefPubMedGoogle Scholar
  • 36 Nicolosi F, Spena G. Three-dimensional virtual intraoperative reconstruction: a novel method to explore a virtual neurosurgical field. World Neurosurg 2020; 137: e189-e193
    CrossrefPubMedGoogle Scholar
  • 37 Breese R, Piazza M, Quinsey C, Blatt JE. Tactile skill-based neurosurgical simulators are effective and inexpensive. World Neurosurg 2020; 137: 319-326
    CrossrefPubMedGoogle Scholar
  • 38 Mussi E, Mussa F, Santarelli C. et al. Current practice in preoperative virtual and physical simulation in neurosurgery. Bioengineering (Basel) 2020; 7 (01) E7
    CrossrefPubMedGoogle Scholar
  • 39 Dardick J, Allen S, Scoco A, Zampolin RL, Altschul DJ. Virtual reality simulation of neuroendovascular intervention improves procedure speed in a cohort of trainees. Surg Neurol Int 2019; 10: 184
    CrossrefPubMedGoogle Scholar
  • 40 Reisch R, Stadie A, Kockro R, Gawish I, Schwandt E, Hopf N. The minimally invasive supraorbital subfrontal key-hole approach for surgical treatment of temporomesial lesions of the dominant hemisphere. Minim Invasive Neurosurg 2009; 52 (04) 163-169
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 41 Komatsu F, Imai M, Shigematsu H. et al. Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note. J Neurosurg 2018; 128 (06) 1873-1879
    CrossrefPubMedGoogle Scholar