The Supraorbital Approach: An Alternative to Traditional Exposure for the Surgical Management of Anterior Fossa and Parasellar Pathology

Abstract

Object: The use of a supraorbital craniotomy as a minimally invasive neurosurgical technique to treat pathology located in the anterior cranial fossa and parasellar region is reported. Materials and Methods: 25 patients were operated upon using the supraorbital keyhole technique to expose various lesions located in the anterior skull base. Included were benign and malignant tumors, AVM, tuberculoma and trauma. Discussion and Conclusion: Utilizing small eyebrow incisions, a small supraorbital (“keyhole”) craniotomy, and microneurosurgical and/or endoscopically assisted access, allowed us to gain excellent optimal and safe exposure to a number of different pathologies of the anterior base and parasellar regions. The lesions were resected under complete control and with full preservation of surrounding neurovascular structures.

Skull base surgery - supraorbital - anterior fossa - parasellar

References

• 1 Perneczky A, Muller-Forell W, Lindert E van, Fries G. Keyhole Concept in Neurosurgery. Stuttgart, New York: Thieme 1999
• 2 Jho H-D, Alfieri A. Endoscopic glabellar approach to the anterior skull base: A technical note.  Minim Invas Neurosurg. 2002;  45 185-188
• 3 Fries G, Perneczky A. Contralateral and ipsilateral microsurgical approach to carotid-ophthalmic aneurysms.  Neurosurgery. 1997;  41 333-343
• 4 Lindert E, 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
• 5 Perneczky A, Fries G. Endoscopic-assisted brain surgery: part 1 - evolution, basic concept, and current technique.  Neurosurgery. 1998;  42 219-225
• 6 Fries G, Perneczky A. Endoscopic-assisted brain surgery: part 2 - analysis of 380 procedures.  Neurosurgery. 1998;  42 226-232
• 7 Taniguchi M, Perneczky A. Subtemporal keyhole approach to the suprasellar and petroclival region: microanatomic considerations and clinical application.  Neurosurgery. 1997;  41 595-601