Endoscopic-Assisted Microsurgical Technique for Management of Anterior Cranial Fossa Lesions Using the Keyhole Supraorbital Approach

Introduction: The priority in neurosurgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury. The concept of keyhole surgery is based on preoperative study of diagnostic images to determine the anatomic windows that provide access to the pathological processes. The supraorbital subfrontal approach expose the suprasellar anatomic structures free for surgical dissection. The endoscope allows the “surgeon’s eye “to penetrate the depth and width of the access route. Methods: During a 17-year period between 1995 and 2012 we have performed endoscope-assisted microsurgical procedures for: aneurysm 274, anterior cranial fossa meningioma 137, craniopharyngiomas 68, arachnoid cysts 42, astrocytoma 24, epidermoids/dermoid 39, pituitary adenoma 58, germinoma 8, teratoma 11, hamartoma 5. Results: Postoperative complications associated with approach were: supraorbital hypesthesia 17, palsy of the frontal muscle 12, permanent hyposmia in 24, wound healing disturbances 3, CSF collection and leak 11 patients. Conclusion: The supraorbital craniotomy allows a wide exposure for deep-seated intracranial areas it offers equal surgical possibilities with less approach-related morbidity. The optical advantages of the endoscopic visualization in anatomical orientation and tumor removal improve the surgical outcome.