The trans-eyebrow supraorbital approach for removal of anterior cranial fossa and suprasellar meningiomas

Abstract

Supraorbital trans-eyebrow craniotomy provides a minimally invasive approach for removing most anterior cranial fossa base and suprasellar tumors. The advantages of keyhole surgery, in comparison with traditional craniotomies, are minimal complications associated with the approach.

Two Cases of Frontal Sinus Inverted Papilloma Treated With a Combined Bifrontal Craniotomy and Endonasal Endoscopic Approach

“…The supraorbital trans-eyebrow approach is a technique in which a skin incision is made in the eyebrow, extending from the supraorbital notch medially to the lateral aspect and dissecting the frontal subgaleal flap superiorly and the superior portion of the temporalis muscle laterally for exposure of the craniotomy site [11]. The small incision, hidden by the eyebrow, has a better cosmetic result and, with less temporalis muscle dissection, a lower incidence of facial nerve frontalis branch damage, scalp pain, temporalis muscle atrophy, and mastication disorders [11,12]. Resection of the upper supraorbital rim enables wider access to the anterior cranial fossa and the suprasellar region, and the need for brain retraction is decreased, minimizing neurologic complications [11,12].…”

“…The small incision, hidden by the eyebrow, has a better cosmetic result and, with less temporalis muscle dissection, a lower incidence of facial nerve frontalis branch damage, scalp pain, temporalis muscle atrophy, and mastication disorders [11,12]. Resection of the upper supraorbital rim enables wider access to the anterior cranial fossa and the suprasellar region, and the need for brain retraction is decreased, minimizing neurologic complications [11,12]. However, the disadvantages include 1) a narrow surgical corridor in the vertical and horizontal directions that could limit manipulation [11,12]; 2) the possibility that adjacent structures could hinder visualization, such as the orbital roof limiting view of the anterior cranial fossa and the lesser sphenoid wing limiting view of the middle cranial fossa and cavernous sinus [12]; 3) the risk that injury of the facial nerve frontal branch could lead to paralysis of the frontalis muscle, which raises the eyebrow [12]; and 4) the fact that depending on individual skin characteristics, some patients experience cosmetic problems, including eyebrow alopecia, visible scarring, and bone defects [11].…”