The Supraorbital Keyhole Approach via an Eyebrow Incision for Resection of Tumors around the Sella and the Anterior Skull Base

Abstract

Objective: This study evaluates the technique, indications, advantages and limitations of the minimal invasive supraorbital keyhole approach via an eyebrow skin incision for resection of tumors around the sella and the anterior skull base.

Methods and Results: In 9 patients (5 males, 4 females) different tumors (6 meningiomas, 1 craniopharyngioma, 1 Rathke's cleft cyst and 1 hypophysitis) with a maximum diameter of 30 millimeters were resected via a small eyebrow incision and a supraorbital keyhole craniotomy. Details of the operative procedure include the use of a high-speed drill, a microsaw, bayonet-shaped instruments, careful microsurgical dissection, the use of a neuroendoscope and miniplates for closure. In all patients complete tumor removal was achieved. Mean duration of surgery was 01 h 51 min and mean hospital stay was 8.9 days. There were no significant postoperative complications. Clinical examination and MR imaging after a mean follow-up of 313 days revealed no tumor recurrence and a very satisfying overall functional and cosmetic result in all patients.

Conclusion: The eyebrow incision supraorbital keyhole approach proved to be safe, effective and time-sparing. The authors recommend this approach for resection of small tumors around the sella and the anterior skull base in selected cases as a valuable alternative to standard skull base approaches.

Keyhole approach - eyebrow incision - anterior skull base - skull base surgery - endoscopy-assisted surgery

References

• 1 Delashaw Jr J B, Tedeschi H, Rhoton A L. Modified supraorbital craniotomy: technical note.  Neurosurgery. 1992;  30 954-956
• 2 Delashaw Jr J B, Jane J A, Kassell N F, Luce C. Supraorbital craniotomy by fracture of the anterior orbital roof. Technical note.  J Neurosurg. 1993;  79 615-618
• 3 Jho H D. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach.  Minim Invasive Neurosurg. 1997;  40 91-97
• 4 Czirjak S, Szeifert G T. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision.  Neurosurgery. 2001;  48 145-149; discussion 149 - 150
• 5 Dare A O, Landi M K, Lopes D K, Grand W. Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. Technical note.  J Neurosurg. 2001;  95 714-718
• 6 Paladino J, Pirker N, Stimac D, Stern-Padovan R. Eyebrow keyhole approach in vascular neurosurgery.  Minim Invasive Neurosurg. 1998;  41 200-203
• 7 Ramos-Zuniga R, Velazquez H, Barajas M A, Lopez R, Sanchez E, Trejo S. Transsupraorbital approach to supratentorial aneurysms.  Neurosurgery. 2002;  51 125-130; discussion 30 - 31
• 8 Steiger H J, Schmid-Elsaesser R, Stummer W, Uhl E. Transorbital keyhole approach to anterior communicating artery aneurysms.  Neurosurgery. 2001;  48 347-351; discussion 351 - 352
• 9 Lindert E van, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique.  Surg Neurol. 1998;  49 481-489; discussion 489 - 490
• 10 Al-Mefty O. Supraorbital-pterional approach to skull base lesions.  Neurosurgery. 1987;  21 474-477
• 11 Brock M, Dietz H. The small frontolateral approach for the microsurgical treatment of intracranial aneurysms.  Neurochirurgia (Stuttg). 1978;  21 185-191
• 12 Jane J A, Park T S, Pobereskin L H, Winn H R, Butler A B. The supraorbital approach: technical note.  Neurosurgery. 1982;  11 537-542
• 13 Kaplan M J, Jane J A, Park T S, Cantrell R W. Supraorbital rim approach to the anterior skull base.  Laryngoscope. 1984;  94 1137-1139
• 14 Smith R R, Al-Mefty O, Middleton T H. An orbitocranial approach to complex aneurysms of the anterior circulation.  Neurosurgery. 1989;  24 385-391
• 15 Perneczky A, Müller-Forell W, Lindert E van, Fries G. Keyhole concept in neurosurgery: with endoscope-assisted microsurgery and case studies. Stuttgart, New York: Thieme 1999