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J Neurol Surg B Skull Base
DOI: 10.1055/a-2297-3768
Original Article

Supraorbital Keyhole Approach: Opening of the Frontal Sinus and Cerebrospinal Fluid Rhinorrhea

Anant Mehrotra
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Kuntal Kanti Das 
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Kamlesh Rangari
2   Neurosurgery, Trauma Care Centre and GMCH, Nagpur, India
,
Soumen Kanjilal
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Pooja Tataskar
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Pawan Kumar Verma
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Kamlesh S. Bhaisora
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Awadhesh Jaiswal
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Raj Kumar
1   Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract

Introduction: The supraorbital keyhole approach (SOKHA) has been a less invasive alternative for anterior and middle skull base lesions. We aimed to review our data and understand the advantages and limitations of the approach.

Methods: We analyzed our data and reviewed 89 consecutive cases who underwent the SOKHA. We included the clinico-radiological parameters, pathology, use of endoscope, complications, etc. for analysis.

Results: A total of 47 patients were of aneurysm with a total of 48 aneurysms (39 were ruptured and 9 were unruptured) and Acomm artery aneurysm was the most common site. Meningiomas were the second most common pathology encountered (n = 29). Tuberculum sella meningioma being the most common type of meningiomas operated through this approach. Gross total resection was done in all except two cases in which a small part of the tumor was left behind as the tumor was adhered to blood vessels. Among the remaining cases, craniopharyngiomas (n = 7), optic pathway gliomas (n = 2), hypothalamic hamartomas (n = 2), dermoid (n = 1), and arteriovenous malformation (n = 1) were the other pathologies operated upon. Eight patients had opening of the frontal sinus. Four patients had wound bulge and one patient had cerebrospinal fluid (CSF) rhinorrhea. All these cases were managed conservatively.

Conclusion: SOKHA is an excellent approach for anterior cranial fossa lesions especially with properly chosen cases. Incidence of CSF leak in our study is 1.1% and majority can be managed by placement of lumbar drain. Intraoperative obliteration of the frontal sinus can reduce the risk of postoperative CSF leak. A large frontal sinus needs not be a contraindication for SOKHA.

Keywords

SOKHA - CSF leak - frontal sinus


Publication History

Received: 22 January 2024

Accepted: 22 March 2024

Accepted Manuscript online:
01 April 2024

Article published online:
30 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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