Transpalpebral “Eyelid” Approach for Supraorbital Frontal Craniotomy and Access to the Anterior Cranial Fossa

Abstract

inimally invasive approaches to anterior cranial fossa surgery have evolved markedly over the past few decades, and supraorbital frontal craniotomy using a ciliary or transciliary incision is now performed commonly compared with standard frontotemporal approaches. 1-21 However, both ciliary and transciliary incisions for minicraniotomy entail compromising the frontalis muscle, and as a corollary, eyebrow asymmetry and disruption of the eyebrow hair follicles, leading to local alopecia. [14][15][16] The transpalpebral eyelid approach is an innovative alternative that mitigates visible scars to improve postoperative aesthetic outcomes. This Summary: The transpalpebral eyelid approach is an innovative alternative to traditional incisions for exposure of the anterior cranial fossa for neurosurgery. However, there is a paucity of data on this surgical technique in the plastic surgery literature for accessing the anterior cranial fossa. A retrospective review was performed of patients who underwent supraorbital frontal craniotomy using an anterior skull base approach with transpalpebral exposure over 8 years by a single plastic surgeon. Surgical techniques, medical comorbidities, intraoperative complications, and long-term complications were assessed. Twenty patients (mean age 52 ± 12 years, 55% male, 45% female) underwent supraorbital frontal craniotomy using an anterior skull base approach with upper transpalpebral exposure. Operative indications included the following: 75% had anterior communicating aneurysms, with a mean aneurysm size of 5.36 ± 1.91 mm; 10% had meningiomas; 10% had dural fistulas; and 5% had an orbital hemangioma. A total of 60% of patients had a smoking history. No intraoperative complications were encountered, and no cases required conversion to a traditional open approach. Mean length of hospital stay was 3.2 ± 1.5 days. Postoperative imaging revealed no residual or recurrent pathology. Mean follow-up time was 62.2 ± 30.6 months. No long-term neurologic or ophthalmologic complications or infections occurred. No forehead paresthesias, brow ptosis, or brow paralysis were noted. The transpalpebral technique is a safe, minimally invasive method to approach lesions of the anterior cranial fossa. Successful application may require appropriate management of the frontal sinus and supraorbital nerve. This approach does not limit neurosurgical access or results and led to no neurosurgical complications.