Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus
15 April 2019
12 November 2019
24 January 2020 (online)
Background The eyebrow orbitozygomatic craniotomy is a minimally invasive approach that can access a wide variety of lesions. Unintentional breach of the frontal sinus frequently occurs and has been cited as a reason to avoid this approach. Lack of access to a large pericranial graft and the inability to completely cranialize the sinus requires alternate techniques of sinus repair. We describe a technique for repairing an opened frontal sinus and retrospectively reviewed complications related to this approach.
Methods All patients, who underwent an orbitozygomatic craniotomy via an eyebrow incision by a single surgeon from August 1, 2012 to August 31, 2018, were included in this retrospective analysis. Data were collected on patient demographics, pathology treated, operative details, and perioperative morbidity. Follow-up ranged from 6 weeks to 6 years.
Results Total 50 patients with a wide variety of pathologies underwent analysis. Frontal sinus breach occurred in 21 patients. All were repaired by the described technique. One patient (ruptured aneurysm) had a suspected cerebrospinal fluid (CSF) leak postoperatively that resolved without any additional intervention. One patient developed a pneumomeningocele 4 years postoperatively that required reoperation. No patient suffered any infection or delayed CSF leak.
Conclusion Breach of the frontal sinus is common during eyebrow craniotomies. Despite reduced options for local repair, these patients have experienced no CSF leaks requiring intervention and no infections in our series. Long-term mucocele risk is not reliably determined with our length of follow-up. Breach of the frontal sinus is not a contraindication to the eyebrow approach.
- 1 Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 2003; 59 (03) 223-227
- 2 Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg 2014; 82 (6, Suppl): S72-S80
- 3 Zumofen DW, Rychen J, Roethlisberger M. , et al. A review of the literature on the transciliary supraorbital keyhole approach. World Neurosurg 2017; 98: 614-624
- 4 Reisch R, Marcus HJ, Hugelshofer M, Koechlin NO, Stadie A, Kockro RA. Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision. J Neurosurg 2014; 121 (03) 730-734
- 5 Dlouhy BJ, Chae MP, Teo C. The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. J Neurosurg Pediatr 2015; 15 (01) 12-19
- 6 Eroglu U, Shah K, Bozkurt M. , et al. supraorbital keyhole approach: lessons learned from 106 operative cases. World Neurosurg 2019; S1878-8750(19)30060-9
- 7 Thaher F, Hopf N, Hickmann AK. , et al. Supraorbital keyhole approach to the skull base: evaluation of complications related to CSF fistulas and opened frontal sinus. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (06) 433-437
- 8 Caroli E, Rocchi G, D'Andrea G, Delfini R. Management of the entered frontal sinus. Neurosurg Rev 2004; 27 (04) 286-288
- 9 Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal sinus breach during routine frontal craniotomy significantly increases risk of surgical site infection: 10-year retrospective analysis. Neurosurgery 2017; 81 (03) 504-511
- 10 Farag A, Rosen MR, Ziegler N. , et al. Management and surveillance of frontal sinus violation following craniotomy. J Neurol Surg B Skull Base 2019; DOI: 10.1055/s-0038-1676826.
- 11 Meetze K, Palmer JN, Schlosser RJ. Frontal sinus complications after frontal craniotomy. Laryngoscope 2004; 114 (05) 945-948
- 12 Horowitz G, Amit M, Ben-Ari O. , et al. Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions. PLoS One 2013; 8 (12) e83820