Early Experience with the Supraorbital Keyhole Craniotomy Through an Eyebrow Incision

Objective: The evolution of microsurgical techniques enables neurosurgeons to treat various lesions through limited keyhole approaches. The supraorbital keyhole craniotomy via an eyebrow incision is a less invasive approach for accessing anterior skull base lesions. This approach has been used to access a number of pathologies including tumors and vascular abnormalities. Surgeons can access lesions in the subfrontal, suprasellar, Sylvian fissure, and posterior fossa regions. We report our experience with this minimally invasive technique with discussion on the indications, limitations and key aspects of perioperative management.

Methods: The supraorbital keyhole approach is performed through an eyebrow skin incision. After an eyebrow skin incision with careful soft tissue dissection, a limited supraorbital craniotomy is carried out with a diameter of about 25 × 15 mm. A limited supraorbital keyhole craniotomy is fashioned.

Results: Between 2018 and 2022, a total of 32 patients underwent the supraorbital keyhole craniotomy via an eyebrow incision. The lesions treated with the supraorbital approach comprised 25 intracranial tumors, 4 traumatic brain injuries, and 3 infectious diseases. Among 25 patients with intracranial tumors, 4 patients had brain metastases, 8 had intracranial meningiomas, and 6 had pituitary adenoma or cyst. The other 7 patients had craniopharyngioma, germinoma, glioma, lymphoma, and others. Most of patients were operated on with favorable postoperative and cosmetic outcomes. Postoperative complication occurred in 1 patient.

Conclusion: In our experience, the supraorbital keyhole craniotomy appears to be a safe and effective treatment modality for neurosurgical lesions in the anterior skull base. This approach provides minimally invasive access to a wide range of the anterior cranial fossa or sellar/parasellar. In addition, the eyebrow skin incision and careful soft tissue dissection result in a satisfactory cosmetic result.

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Artikel online veröffentlicht:
05. Februar 2024