J Neurol Surg B Skull Base 2017; 78(06): 481-489
DOI: 10.1055/s-0037-1604408
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Postoperative Imaging Findings Associated with Transpalpebral Craniotomy Approach to Anterior Cranial Fossa

Dennis Monks
1   Department of Radiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Allison Weyer
2   Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Peter Thurlow
3   Department of Radiology, University of Wisconsin, Madison, Wisconsin, United States
,
Khaled Aziz
4   Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Erik Happ
5   Department of Ophthalmology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Michael Goldberg
1   Department of Radiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

18 January 2017

17 June 2017

Publication Date:
31 July 2017 (online)

Abstract

Background and Purpose The transpalpebral “eyelid” approach is a novel alternative to the traditional ciliary or supraciliary incision for supraorbital frontal craniotomy and access to the anterior cranial fossa. Though a prior publication from our institution has described the surgical approach in detail along with cosmetic and clinical outcomes, postoperative imaging findings have not yet been described. As this surgical technique becomes more widely practiced, it is essential for neuroradiologists, oculoplastic surgeons, and skull base neurosurgeons to be familiar with the expected postoperative imaging findings, especially those that prompt subsequent intervention.

Materials and Methods A retrospective, institutional review board approved review was performed of 102 patients who underwent transpalpebral surgical approach at Allegheny General Hospital from June 2007 through May 2015. Operative reports, pathology reports, preoperative imaging, postoperative imaging, and postoperative clinical documentation were reviewed.

Results Forty-nine percent of patients had solely benign expected postoperative imaging findings, 37% had various atypical findings not requiring further intervention (most commonly asymmetric globe protrusion and bone cement in a paranasal sinus), 6% had findings prompting minimally invasive bedside procedures (most commonly pseudomeningocele), and 8% had findings requiring surgical intervention.

Conclusion The majority of imaging following the transpalpebral approach showed typical, benign findings, such as minimal pneumocephalus and asymmetric globe protrusion. Nonetheless, members of the clinical team should be aware of the small number of findings requiring intervention, especially pseudomeningocele.

 
  • References

  • 1 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005; 57 (4, Suppl) 242-255 ; discussion 242–255
  • 2 Fischer G, Stadie A, Reisch R. , et al. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery 2011; 68 (1, Suppl Operative) 45-51 ; discussion 51
  • 3 Czirják S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery 2001; 48 (01) 145-149 ; discussion 149–150
  • 4 Dare AO, Landi MK, Lopes DK, Grand W. Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. Technical note. J Neurosurg 2001; 95 (04) 714-718
  • 5 Jallo GI, Bognár L. Eyebrow surgery: the supraciliary craniotomy: technical note. Neurosurgery 2006; 59 (01) (Suppl. 01) E157-E158 ; discussion E157–E158
  • 6 Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg 1997; 40 (03) 91-97
  • 7 Mitchell P, Vindlacheruvu RR, Mahmood K, Ashpole RD, Grivas A, Mendelow AD. Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms. Surg Neurol 2005; 63 (01) 47-51 , discussion 51
  • 8 Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 2003; 59 (03) 223-227
  • 9 Sánchez-Vázquez MA, Barrera-Calatayud P, Mejia-Villela M. , et al. Transciliary subfrontal craniotomy for anterior skull base lesions. Technical note. J Neurosurg 1999; 91 (05) 892-896
  • 10 Lupret V, Sajko T, Beros V, Kudelic N, Lupret Jr V. Advantages and disadvantages of the supraorbital keyhole approach to intracranial aneurysms. Acta Clin Croat 2006; 45 (02) 91-94
  • 11 Czirják S, Nyáry I, Futó J, Szeifert GT. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol 2002; 57 (05) 314-323 ; discussion 323–324
  • 12 Ramos-Zúñiga R, Velázquez H, Barajas MA, López R, Sánchez E, Trejo S. Trans-supraorbital approach to supratentorial aneurysms. Neurosurgery 2002; 51 (01) 125-130 ; discussion 130–131
  • 13 Steiger HJ, Schmid-Elsaesser R, Stummer W, Uhl E. Transorbital keyhole approach to anterior communicating artery aneurysms. Neurosurgery 2001; 48 (02) 347-351 ; discussion 351–352
  • 14 van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 1998; 49 (05) 481-489 ; discussion 489–490
  • 15 Figueiredo EG, Deshmukh V, Nakaji P. , et al. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 2006; 59 (04) (Suppl. 02) ONS212-ONS220 ; discussion ONS220
  • 16 Ohjimi H, Taniguchi Y, Tanahashi S, Era K, Fukushima T. Accessing the orbital roof via an eyelid incision: the transpalpebral approach. Skull Base Surg 2000; 10 (04) 211-216
  • 17 Abdel Aziz KM, Bhatia S, Tantawy MH. , et al. Minimally invasive transpalpebral “eyelid” approach to the anterior cranial base. Neurosurgery 2011; 69 (2, Suppl Operative) ons195-ons206 ; discussion 206–207
  • 18 Andaluz N, Romano A, Reddy LV, Zuccarello M. Eyelid approach to the anterior cranial base. J Neurosurg 2008; 109 (02) 341-346
  • 19 Owusu Boahene KD, Lim M, Chu E, Quinones-Hinojosa A. Transpalpebral orbitofrontal craniotomy: a minimally invasive approach to anterior cranial vault lesions. Skull Base 2010; 20 (04) 237-244
  • 20 Schmidt BL, Pogrel MA, Hakim-Faal Z. The course of the temporal branch of the facial nerve in the periorbital region. J Oral Maxillofac Surg 2001; 59 (02) 178-184