Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus

Abstract

Background The eyebrow orbitozygomatic craniotomy is a minimally invasive approach that can access a wide variety of lesions. Unintentional breach of the frontal sinus frequently occurs and has been cited as a reason to avoid this approach. Lack of access to a large pericranial graft and the inability to completely cranialize the sinus requires alternate techniques of sinus repair. We describe a technique for repairing an opened frontal sinus and retrospectively reviewed complications related to this approach. Methods All patients, who underwent an orbitozygomatic craniotomy via an eyebrow incision by a single surgeon from August 1, 2012 to August 31, 2018, were included in this retrospective analysis. Data were collected on patient demographics, pathology treated, operative details, and perioperative morbidity. Follow-up ranged from 6 weeks to 6 years. Results Total 50 patients with a wide variety of pathologies underwent analysis. Frontal sinus breach occurred in 21 patients. All were repaired by the described technique. One patient (ruptured aneurysm) had a suspected cerebrospinal fluid (CSF) leak postoperatively that resolved without any additional intervention. One patient developed a pneumomeningocele 4 years postoperatively that required reoperation. No patient suffered any infection or delayed CSF leak. Conclusion Breach of the frontal sinus is common during eyebrow craniotomies. Despite reduced options for local repair, these patients have experienced no CSF leaks requiring intervention and no infections in our series. Long-term mucocele risk is not reliably determined with our length of follow-up. Breach of the frontal sinus is not a contraindication to the eyebrow approach.

Standard Orbitozygomatic Craniotomy versus Mini Orbitozygomatic Craniotomy via an Eyebrow Incision for Microsurgical Treatment of Anterior Communicating Artery Aneurysms

“…10 We have previously described our novel technique for frontal sinus repair during an eyebrow OZ, and we have had no infections, mucoceles, or delayed CSF leaks with our method. 12 If recognized and properly addressed intraoperatively, unintentional opening of the frontal sinus does not add significant risk. There are several limitations to this study.…”

“…Figure 1 shows the standard OZ used in this series. We have previously described our technique for the eyebrow mini-OZ [12] . Briefly, a small incision is made completely within the eyebrow.…”

“…We have previously described our technique for the eyebrow mini-OZ. 12 Briefly, a small incision is made completely within the eyebrow. A burr hole is placed at the keyhole and craniotome is used to turn a small supraorbital cut.…”