Comparative Analysis of Exposure and Maneuverability Provided by the Keyhole Supraorbital Eyebrow Approach and Superior Eyelid Endoscopic-Assisted Approach to the Anterior Cranial Fossa

Introduction: The keyhole supraorbital eyebrow approach (KSEA) and superior eyelid endoscopic-assisted approach (SEEA) have been studied and described as minimally invasive approaches to the anterior cranial fossa (ACF), preventing the need for brain retraction with favorable cosmetic outcomes. Understanding the surgical nuances of these approaches may facilitate approach selection for individual lesions of the ACF.

Objective: To evaluate and compare the area of exposure, surgical freedom, and angle of attack between the KSEA and SEEA.

Methods: A KSEA (first) and SEEA (second) approaches were performed on 5 cadaveric specimens bilaterally (10 sides total). Area of exposure (AOE), surgical freedom (SF), and angle of attack (AA) to relevant ipsilateral and contralateral ACF neurovascular structures (ACP, optic nerve, optic chiasm) were visualized, and their positions were confirmed and registered with neuronavigation assistance for posterior analysis.

Results: Both KSEA and SEEA offered adequate access to the ipsilateral anterior cranial fossa. There was no significant difference in area of exposure, surgical freedom, and angle of attack to the ipsilateral ACF. There was a greater area of exposure for the KSEA to the contralateral side. The surgical freedom and angle of attack were also superior in KSEA to the contralateral side.

Conclusion: There were no statistically significant differences in our study variables for an ipsilateral approach to the ACF between the KSEA and SEEA. Our study variables, however, were superior in the KSEA compared with the SEEA to the contralateral ACF. Understanding the anterior cranial fossa limitations for each approach will help facilitate proper microsurgical approach selection for individual cases. Further studies are necessary to better define their surgical application.

Publication History

Article published online:
15 February 2022