Supraorbital Keyhole Craniotomy via Eyebrow Incision: A Systematic Review and Meta-Analysis

Robinow, Zoe; Peterson, Catherine; Waldau, Ben; Shahlaie, Kiarash

doi:10.1016/j.wneu.2021.11.015

Cited by 20 publications

(16 citation statements)

References 107 publications

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“…The DI is one of the most common postoperative endocrine complications in TS meningioma resection. 27 In the present study, we described a case of DI associated with intraoperative pituitary stalk injury with bipolar cautery. ►Fig.…”

Section: Discussionmentioning

confidence: 80%

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Iranmehr,

Chavoshi,

Zeinalizadeh

2024

J Neurol Surg B Skull Base

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Objectives In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case–control analysis. Methods This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case–control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery. Results The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD (p-value = 1). Conclusion ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.

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Section: Discussionmentioning

confidence: 80%

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Iranmehr,

Chavoshi,

Zeinalizadeh

2024

J Neurol Surg B Skull Base

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“…In our recent systematic review of supraorbital keyhole craniotomy via eyebrow incision, an 83.6% technical success rate, defined as gross total tumor resection or complete aneurysm obliteration via clipping, was achieved despite rare inclusion of orbital osteotomy. 2 The increased working angles achieved with orbital osteotomy must be balanced against the increased tissue manipulation and worsened cosmetic outcomes. Ultimately, inclusion of orbital osteotomy is left to the surgeon's discretion and may be maximally beneficial when using a supraorbital transpalpebral approach instead.…”

Section: Factors Affecting Patient Cosmesismentioning

confidence: 99%

“…In a recent meta-analysis, our group found that the supraorbital keyhole approach has high technical success rate with generally low complications and mortality in the treatment of both tumor and vascular pathologies, particularly in patients with anterior skull base extra-axial tumors and anterior circulation aneurysms. 2 The craniofacial nature of this approach has important implications for cosmetic outcomes and there are significant variations in the surgical technique used for the supraorbital keyhole approach. 9 10 Therefore, the potential impact of these technical variations used in the supraorbital eyebrow approach on cosmetic outcomes is an important consideration that needs to be explored further.…”

Section: Introductionmentioning

confidence: 99%

“…The supraorbital keyhole craniotomy has gained traction as an effective and minimally invasive neurosurgical technique for the management of various lesions of the anterior and middle cranial fossae. [1][2][3][4] As a less-invasive alternative to the traditional pterional craniotomy, the supraorbital keyhole craniotomy helps avoid the risks of soft tissue and temporalis muscle injury, facial nerve palsy, frontal sinus violation, odynophagia, and temporal hollowing. 1,5 Prior studies have found that the supraorbital keyhole craniotomy has a similar safety and efficacy profile to the standard larger craniotomies.…”

Section: Introductionmentioning

confidence: 99%

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

Robinow

Peterson

Riestenberg

et al. 2022

J Neurol Surg B Skull Base

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Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal craniotomy and is often used for tumor and vascular pathologies. The purpose of this study was to investigate how patient cosmetic outcomes are affected by technique variations of this approach. Methods PubMed, Embase, and Scopus databases were systematically searched, and results were reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian–Laird random effects model was used, and the primary end points were patient satisfaction and percentage of permanent cosmetic complications. Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable cosmetic outcome following supraorbital craniotomy, and mean number of cases with permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are associated with more favorable cosmetic outcomes than tumor cases ( p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse cosmetic outcomes ( p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics, and addition of pressure dressing did not significantly impact cosmetic outcomes ( p > 0.05 for all). Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole approach do not pose significant cosmetic risks, utilization of an orbital osteotomy and the addition of a drain correlate with unfavorable cosmetic outcomes.

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“…The supraorbital approach has been shown as the most suitable method for TSM treatment, offering the advantages of less trauma and faster recovery compared with other TCAs ( 5 , 6 ). Some scholars have proposed that there are blind areas in the microscopical approach through the eyebrow arch, and the use of angle neuroendoscopy can effectively solve this problem ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Keyhole supraorbital eyebrow approach for fully endoscopic resection of tuberculum sellae meningioma

et al. 2022

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BackgroundThe fully endoscopic supraorbital trans-eyebrow keyhole approach is a technique utilized for the transcranial resection of tuberculum sellae meningioma (TSM). Surgery is the first choice for TSM treatment. This study aimed to summarize and analyze the safety, feasibility, limitations, and technical requirements of the fully endoscopic supraorbital trans-eyebrow keyhole approach for TSM resection.MethodsData of 19 TSM fully endoscopic supraorbital trans-eyebrow keyhole approach resections cases (six and 13 on the left and right eyebrows, respectively) were retrospectively analyzed at the Neurosurgery Department of the First Affiliated Hospital of Bengbu Medical College (Bengbu, China) from August 2015 to March 2022.ResultsAll 19 patients were diagnosed with meningioma (World Health Organization grade I), and according to the scope of tumor resection (EOR), 18 patients (94.7%) had gross total resection (GTR), and one patient (5.3%) had near-total resection (NTR). Preoperative chief complaints were symptomatic visual dysfunction (n = 12), headache and dizziness (n = 6), and accidental discovery (n = 1). Postoperative visual function improved in 83.3% of cases (10/12), and headache and dizziness were relieved in 83.3% of cases (5/6 patients). Postoperative intracranial infection occurred in one case and was cured by external drainage of the lumbar cistern and anti-infective treatment. Two cases of frontal lobe injury were discharged after conservative treatment. There was no postoperative olfactory dysfunction, eyelid ptosis, cerebrospinal fluid leakage, or death. There were no reports of disease recurrence or death during the 3-month follow-up at an outpatient clinic or by telephone.ConclusionFully endoscopic TSM resection through the keyhole approach is safe and feasible. It can be used to explore angles that cannot be seen under a microscope and show the true value of endoscopy technology. The endoscopic equipment and technical skills of the surgeon and surgical team are important in this technique.

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Supraorbital Keyhole Craniotomy via Eyebrow Incision: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 107 publications

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

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

Keyhole supraorbital eyebrow approach for fully endoscopic resection of tuberculum sellae meningioma

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