Postoperative Imaging of the Transpalpebral “Eyelid” Approach for the Surgical Treatment of Anterior Cranial Fossa Lesions: What the Neuroradiologist and Skull Base Surgeon Need to Know

Purpose: The purposes of this study are: (1) To introduce the transpalpebral “eyelid” approach for the surgical treatment of anterior cranial fossa lesions with review of the relevant skull base, orbital, and periorbital anatomy, (2) to review the expected postoperative imaging findings following the transpalpebral approach to the anterior cranial fossa, and (3) to discuss complications associated with this relatively new surgical technique.

Description: The concept of minimally invasive skull base surgery has evolved considerably during the last couple of decades, and it is critical for the neuroradiologist and skull base surgeon to be aware of these developing surgical techniques and expected postoperative imaging appearances. The neurosurgical department at our institution has adapted the traditional supraorbital frontal mini-craniotomy for anterior cranial fossa lesions by utilizing the natural skin crease of the upper eyelid rather than the more traditional ciliary or supraciliary approach.

Fifty patients have undergone this treatment at our institution for a variety of indications (most commonly anterior circulation aneurysm and meningioma), the largest case series at a single institution to date. Based on this experience, the purpose of our presentation will be to (1) describe this technique in detail and review the relevant anatomy; (2) review the expected postoperative imaging findings, such as the unique bony defect seen in this type of craniotomy; and (3) review the wide range of complications that can be well characterized on imaging, including eyelid hematoma, infection, exophthalmos/enophthalmos, CSF leak, and cerebrovascular accident.

Summary: This study (1) introduced and described the transpalpebral “eyelid” approach for surgical treatment of anterior cranial fossa lesions, a relatively new technique that is gaining broader use in the neurosurgical community; (2) reviewed the relevant skull base, orbital, and periorbital anatomy; and (3) reviewed postoperative imaging findings, including complications.