Anterolateral Mini Fronto-Orbito-Zygomatic Craniotomy via an Eyebrow Incision in Pediatrics: Technical Notes and Evaluation

Abstract

Background: Various approaches to lesions in the anterior cranial fossa and sellar region have been described by different authors under various names which describe the extent of craniotomies. The aims of this study were to describe and retrospectively analyze and evaluate the anterolateral mini fronto-orbito-zygomatic (MFOZ) approach via an eyebrow incision in treating pediatric pathologies, especially those related to the sellar region. Method: Between January 2003 and December 2008, 18 patients with lesions in the sellar region or the anterior corridor leading to it were operated upon via the same approach. There were 10 males and 8 females. The age ranged between 11 months and 15 years (mean 7.9 years). The pathologies were craniopharyngiomas in 6 cases, hypothalamic and chiasmal pilocytic astrocytoma in 7 and 5 miscellaneous cases including 2 pituitary adenomas, 1 extradural hematoma, hypothalamic hamartoma and 1 arachnoid cyst in the retrosellar and prepontine area. Surgery was performed from the right side in 15 cases and from the left in 3 cases. Results: Total resection was achieved in 9 cases (50%), subtotal resection in 4 cases (22%), and partial resection in 5 cases (28%). Complications related to the approach like CSF rhinorrhea, supraorbital hypoesthesia and loss of upward elevation of the eyebrow were temporary. There was no mortality in this study and no significant added morbidities related to the approach. The approach has the advantages of the small cosmetic eyebrow incision and the skull base trajectory, thus reducing brain retraction and achieving the desired exposure with good outcome. Conclusion: The MFOZ craniotomy using an eyebrow incision in pediatric patients is safe, effective, and both suitable and convenient for treating lesions especially at the sellar region.

Cosmetic Outcomes of Supraorbital Keyhole Craniotomy Via Eyebrow Incision: A Systematic Review and Meta-Analysis

“…This review yielded 124 studies that were eligible, all of which were included in the qualitative and quantitative synthesis as well as risk of bias appraisal. 3 4 7 8 9 10 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83…”

Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach

“…[16171819] These approaches combine supraorbital minicraniotomy with removal of the frontal orbital bar with orbital roof to facilitate better access to intradural lesions. We do not remove either the orbital bar or orbital roof, instead we completely drill away any bony prominences on the orbital roof to flatten the surgical corridor in the base of the anterior cranial fossa.…”

“…Other variants of the lateral supraorbital keyhole are the orbitofrontozygomatic or transorbital keyhole approaches that include removal of the orbital bar with the anterior part of the orbital roof. [16][17][18][19] These approaches combine supraorbital minicraniotomy with removal of the frontal orbital bar with orbital roof to facilitate better access to intradural lesions. We do not remove either the orbital bar or orbital roof, instead we completely drill away any bony prominences on the orbital roof to flatten the surgical corridor in the base of the anterior cranial fossa.…”

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

“…• Type of pathology: Many authors present case series of management of different pathologies of the anterior and middle skull base treated through minimally invasive approaches, in particular aneurysms, 7,9-12 skull base meningiomas, 5,17,18 intra-axial cavernous angiomas, 6 craniopharyngiomas, 19,20 and pituitary adenomas. 18,21 In our opinion, for extra-axial skull base tumors (i.e., meningiomas) or circle of Willis aneurysms, the first step should be to dissect cisterns to drain CSF and relax the brain so that much more working space may be available.…”