The Supraorbital Approach for Removal of Intra-Axial Frontal Brain Tumors: A Technical Note

Introduction: The supraorbital (SO) “eyebrow” craniotomy is commonly used to remove extra-axial frontal fossa and parasellar tumors such as meningiomas and craniopharyngiomas. Herein we present the utility and selection criteria for the SO approach to resect intra-axial frontal lobe brain tumors.

Methodology: All consecutive patients who underwent a SO craniotomy for an intra-axial tumor were retrospectively analyzed for tumor location, pathology, extent of resection, and complications.

Results: Over 28 months, 10 patients (mean age, 67.6 years; 7 women) underwent 11 SO procedures to resect intra-axial brain tumors. Pathology included metastatic carcinoma (n = 07), glioma (n = 02), and radiation necrosis (n = 01). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near total removal was achieved in 80% of the cases. There were no new neurological deficits, postoperative hematomas or CSF leaks.

Conclusion: The SO “eyebrow” craniotomy is a safe and effective keyhole method to remove intra-axial frontal lobe lesions. Tumors in the frontal lobe, for which the shortest distance is through a frontobasal or orbitofrontal trajectory, are ideal for this route, which allows for minimal disruption of normal brain parenchyma. Deeper intra-axial tumors can also be effectively accessed via this route with excellent clinical outcomes.