Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the anterior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retrospectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow approach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscellaneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1–8 days). In 82 patients a total removal of the lesion was performed, while in 15 patients a near-total or subtotal removal was achieved. There were no postoperative hematomas, cerebrospinal fluid leaks, or severe neurological deficits, with the exception of 2 cases of visual deterioration and 1 case each of meningitis, stroke, and third cranial nerve paresis. Other complications directly related to the approach included 2 cases of skin burn as a direct result of heat transmission from the microscope light, 1 case of right frontal palsy, 2 cases of frontal numbness, and 1 case of bone remodeling 1 year after surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive approach to remove extra- and intraaxial anterior skull base, parasellar, and frontal lesions, promoting a rapid recovery and short hospital stay. The location of the eyebrow incision demands a meticulous cosmetic closure, but, with proper technique, cosmetic results are excellent.</jats:p></jats:sec>

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches

“…A large sinus increases the risk of postoperative CSF leakage and alters the surgical trajectory. 17 Combining the supraorbital approach with the endonasal approach when necessary reduced the number of CSF leaks to 0 in our series. The basic concept here is to recognize the limits and limitations of each approach.…”

“…17 A recent literature review has demonstrated that a total of 81 cases of olfactory groove meningiomas removed using the supraorbital eyebrow approach have been reported. 44 Of these, GTR was achieved in 91.4%.…”

Supraorbital Keyhole Craniotomy in Surgery of Intra- And Extra-Axial Brain Tumors

“…В хирургии внутримозговых объемных образова-ний, как глиом, так и метастазов, очень важен детальный предоперационный анализ данных МРТ [7]. В первую очередь важно оценивать, какой тип резекции плани-руется.…”

“…-тотальная: при отсутствии контрастного усиле-ния для опухолей, накапливающих контраст; -почти тотальная: при удалении более 90 % опухоли; -субтотальная: при удалении менее 90 % опухо-ли [7,14].…”

Editorial: The endoscopic keyhole supraorbital approach

“…1 The keyhole supraorbital approach has steadily become a workhorse operation for neurosurgeons who routinely treat tumors and aneurysms in these anatomical regions. 2 The authors are to be acknowledged for further developing this minimally invasive approach and for routinely integrating the endoscope into their practice, which improves overall visualization and facilitates inspection around anatomical corners such as the tuberculum sellae.…”