CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 02): S215-S217
DOI: 10.1055/s-0038-1623520
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Contralateral Eyebrow Approach for Unilateral Suprasellar Meningioma

Sorin Aldea
1   Department of Neurosurgery, Foch Hospital, Suresnes, France
Stéphan Gaillard
1   Department of Neurosurgery, Foch Hospital, Suresnes, France
› Author Affiliations
Further Information

Publication History

12 October 2017

07 December 2017

Publication Date:
19 January 2018 (online)


Unilateral suprasellar meningiomas have distinct features compared to other midline tumors, as they may produce severe visual symptoms even if small due to an early involvement of the optic canal. Surgical treatment of these tumors from an ipsilateral approach is challenging, as the tumor is covered by the optic nerve that needs to be mobilized to access the optic canal extension. A contralateral approach allows a direct line of sight to the tumor despite a longer working distance. We report the case of a 49-year-old patient presenting with unilateral visual loss related to a left suprasellar meningioma extending to the left optic canal and displacing the optic nerve laterally. Through a right eyebrow approach, a 2.5/2 cm supraorbital bone flap was raised and the orbital floor was thoroughly flattened. After dural opening, the carotid cistern was opened and CSF evacuated allowing a surgery without fixed retractors. The intracranial part of the tumor was removed, but the optic nerve seemed to be still displaced by the intracanalicular part. Under copious irrigation, the medial part of the optic canal was drilled, the dura incised, and the tumor removed. Postoperative course was favorable and the patient made a complete visual recovery. Postoperative MRI showed complete removal of the tumor. We present different surgical steps and discuss the nuances of the procedure. The contralateral eyebrow approach is an interesting addition to the surgical armamentarium and should be discussed for unilateral suprasellar tumors.

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