J Neurol Surg B Skull Base
DOI: 10.1055/s-0039-3402025
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus

1  Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina, United States
2  Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, United States
,
Caitlin Payne
3  Department of Neurosurgery, Dartmouth-Hitchcock, Hanover, New Hampshire, United States
,
Scott D. Wait
1  Department of Neurosurgery, Carolinas Medical Center, Charlotte, North Carolina, United States
2  Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, United States
4  Department of Pediatric Neurosurgery, Levine Children's Hospital, Charlotte, North Carolina, United States
› Author Affiliations
Further Information

Publication History

15 April 2019

12 November 2019

Publication Date:
24 January 2020 (online)

Abstract

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.