Frontal orbital approaches to sellar and parasellar tumors

Landeiro, José Alberto; Flores, Marlo Steiner; Lopes, C.A.; Lapenta, Mário Alberto; Ribeiro, Carlos Henrique

doi:10.1016/s0303-8467(97)81339-x

Cited by 2 publications

(2 citation statements)

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“…In 1900 Krause first demonstrated supra-orbital, subfrontal approach on cadaver, then eight years later he reported the first resection of skull base meningioma through this approach 17 . The initial approach to skull base tumors via supra-orbital route developed in early 20 th century, but it has not been popular till recent decades 18,19 . The keyhole "eyebrow" supra-orbital craniotomy was reintroduced with "a concept of geometric construction of the surgical approach with a choice of the correct limited craniotomy as a key characteristic for entering a particular intracranial space and for working with a minimum of traumatization" 15 .…”

Section: Illustrative Casesmentioning

confidence: 99%

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas

Paiva-Neto

Tella

2010

Arq. Neuro-Psiquiatr.

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The improvement of surgical techniques as well as the introduction of new surgical instruments promoted the use of keyhole craniotomies in neurosurgery. We evaluated the technical aspects of the supra-orbital keyhole approach considering the indications, limitations, and complications of this approach to treat anterior cranial fossa and parasellar meningiomas. Twenty-four patients (21 females; mean age, 53±8.6 years) operated on between 2002 and 2006 through a supra-orbital eyebrow approach were studied. Maximal tumor diameter ranged from 1.6 to 6 cm. Gross total resection was done in 20 (83.3%). All tumors were histologically benign. Two patients (8%) experienced CSF rinorhea and another two patients suffered transitory diabetes insipidus (8%). One patient experienced transitory hemiparesis. There was one case of meningitis and one mortality. Follow-up ranged between 6 to 66 months (mean 31.5±20.1 months), with no recurrence. The supra-orbital keyhole craniotomy is a useful minimally invasive approach to treat selected anterior fossa and parasellar meningiomas.

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Section: Illustrative Casesmentioning

confidence: 99%

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas

Paiva-Neto

Tella

2010

Arq. Neuro-Psiquiatr.

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“…23,24 Surface landmarks and preoperative imaging findings have a wide range of applications in neurological surgery; however, there are no correlates that aid in choosing a favorable surgical corridor to suprasellar pathology. 17,[25][26][27] Furthermore, suprasellar pathology often displaces the normal anatomy-particularly the optic nerves and chiasm-making it difficult or even impossible to identify on imaging. In these cases, it would be useful to have a tool to help predict the operative working spaces preoperatively, allowing for a tailored choice of surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Predictors of Transcranial Surgical Access to the Suprasellar Space

Straus

Eddelman

Byrne

et al. 2019

J Neurol Surg B Skull Base

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Objective The suprasellar space is a common location for intracranial lesions. The position of the optic chiasm (prefixed vs. postfixed) results in variable sizes of operative corridors and is thus important to identify when choosing a surgical approach to this region. In this study, we aim to identify relationships between suprasellar anatomy and external cranial metrics to guide in preoperative planning. Methods T2-weighted magnetic resonance images (MRIs) from 50 patients (25 males and 25 females) were analyzed. Various intracranial and extracranial metrics were measured. Statistical analysis was performed to determine any associations between metrics. Results Interoptic space (IOS) size correlated with interpupillary distance (IPD; a = 7.3, 95% confidence interval [CI] = 4.5–10.0, R 2 = 0.3708, p = 0.0009). IOS size also correlated with fixation of the optic chiasm, for prefixed chiasms (n = 7), the mean IOS is 205.14 mm2, for normal chiasm position (n = 33) the mean IOS is 216.94 mm2 and for postfixed chiasms (n = 10) the mean IOS is 236.20 mm2 (p = 0.002). IPD correlates with optic nerve distance (OND; p = 0.1534). Cranial index does not predict OND, IPD, or IOS. Conclusion This study provides insight into relationships between intracranial structures and extracranial metrics. This is the first study to describe a statistically significant correlation between IPD and IOS. Surgical approach can be guided in part by the size of the IOS and its correlates. Particularly small intraoptic space may guide the surgeon away from a subfrontal approach.

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Frontal orbital approaches to sellar and parasellar tumors

Cited by 2 publications

References 0 publications

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas

Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas

Anatomical Predictors of Transcranial Surgical Access to the Suprasellar Space

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