J Neurol Surg B Skull Base 2014; 75 - A006
DOI: 10.1055/s-0034-1370412

Keyhole Supraorbital Approach for Management of Suprasellar Tumors

Firas Hammadi 1, Ali Ayyad 1
  • 1Mainz, DE

Introduction: The priority in contemporary Surgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury.

The evolution of microsurgical techniques with refined instrumentation and illumination and the enormous development of preoperative and intraoperative diagnostic tools enable neurosurgeons to treat different lesions through limited and specific keyhole approaches. The concept of keyhole surgery is based on the careful preoperative study of diagnostic images (MRI, CT, Angiography) to determine the anatomic windows that provide access to the pathological processes, taking into consideration the individual pathoanatomic situation of the patient.

Material and Method: During a 16 years period between 1995 till 2011 we have performed 412 endoscopic assisted microsurgical procedures for suprasellar tumors including:

  • Meningiomas 164

  • Craniopharyngiomas 87

  • Pituitary adenomas 46

  • Epidermoid/Dermoid cysts 36

  • Astrocytomas 29

  • Germinoma 11

  • Teratoma 14

  • Hamartoma 9

Results: The postoperative complications associated with the approach were:

  • permanent partial supraorbital hypesthesia 17 patients

  • Palsy of the frontal branch of the facial nerve appeared 14cases

  • permanent hyposmia appeared 17 patients

  • wound healing disturbances occurred 4 cases

  • subcutaneous CSF collection and leak 8 patients.

  • Postoperative bleeding 9 cases.

Conclusions: The supraorbital craniotomy allows a wide, intracranial exposure for extended, bilaterally situated, or even deep-seated intracranial areas, according to the strategy of keyhole craniotomies. The supraorbital craniotomy offers equal surgical possibilities with less approach-related morbidity owing to limited exposure of the cerebral surface and minimal brain retraction.

The optical advantages of the endoscopic visualization in anatomical orientation and surgical dissection improves the surgical outcome.

All these factors contribute to improve the postoperative results due to reduction of the complications. In addition the minimally invasiveness of the procedure results in pleasing cosmetic outcome