Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Cranial Fossa: A 104 Cases Experience

The minimally invasive approaches for anterior cranial fossa evolved during the past two decades. Supraorbital frontal minicraniotomy with or without orbitotomy is commonly utilized. Here, we describe our experience with transpalpebral eyelid incision utilizing natural upper eyelid crease to obtain an access to the anterior cranial fossa through subfrontal-supraorbital corridor. Eyelid approach reduces the risk of injury to frontalis branch of facial nerve. We reviewed our experience in 104 anterior cranial fossa neoplastic lesions and anterior circulation aneurysms (ICA, Acom, and Pcom). We describe the step-by-step technique and results of 104 anterior cranial fossa lesions. Extracranial drilling of greater sphenoid wing exposes the frontal dura, temporal dura, and periorbital (sphenoorbital keyhole). One piece frontoorbital craniotomy performed in all cases where the bone flap was approximately 2.5 cm in height. Optic foramnotomy and anterior clinoidectomy were added when indicated. After dura open, panoramic view of anterior cranial fossa floor from contralateral to epsilateral; oculomotor nerves 6/101 complications required surgical treatment (two CSF leaks and infection, one infection, one CSF leak, one peumocephalus, and one eyelid hematoma). This is the largest series published utilizing this unique approach with excellent cosmetic outcome in 102/104 patients. The transpalpebral approach provides dissection in natural anatomical planes, preserving frontalis muscle, avoids injury to VII nerve branches, and provide excellent cosmetic outcome.