Minimally Invasive Supraorbital Key-Hole Approach for the Treatment of Anterior Cranial Fossa Meningiomas: Is Still a Valid Option in the Endoscopic Era?

Background: The most important target of minimally invasive surgery is to obtain the best therapeutic effect with the least iatrogenic injury. In this background, a pivotal role in contemporary neurosurgery is played by the supraorbital key-hole approach (SKA) proposed by Perneczky for anterior cranial base surgery. We presented our experience with SKA as a possible valid alternative to the traditional craniotomies in anterior cranial fossa meningiomas removal and to the novel endoscopic endonasal approaches (EEA).

Methods: From January 2012 to January 2018 at our department, 158 patients underwent anterior cranial base meningiomas removal. 80 patients were submitted to traditional approaches while 48 to supraorbital key-hole technique. Then, 30 patients were treated by extended endoscopic endonasal approach. A clinical and neuroradiological pre-, postoperative and a 6-month follow-up evaluation were performed, with attention to eventual complications, length of surgical procedure, and hospitalization.

Results: Compared with traditional approaches the supraorbital key-hole approach was associated to a lower rate of postoperative complications, a lower surgical time and hospitalization while permitting the same lesion control. Compared with the EEA, SKA had a minor rate of CSF leaks and provide a better working angle with better lesion control.

Conclusion: With this technique, minimization of brain exposition and manipulation with reduction of unwanted iatrogenic injuries, neurovascular structures preservation, and a better aesthetic result are possible. The supraorbital key-hole approach according to Perneckzy could represent a valid alternative to traditional approaches in anterior cranial base meningiomas surgery and is also very competitive when compared with the EEA.

No conflict of interest has been declared by the author(s).