KEYHOLE CRANIOTOMY THROUGH an EYEBROW INCISION VERSUS STANDARD CRANIOTOMY for ANTERIOR CRANIAL FOSSA AND SUPRASELLAR NEOPLASMS

Abstract

Background: The enormous development of microsurgical techniquesand instrumentation together with preoperative planningusing the excellent preoperative diagnostic facilitiesavailable, enables neurosurgeons to treat more complicateddiseases through smaller and more specificapproaches. Objective: Describe the supraorbital keyhole approach via an eye brow incision, its indications, advantages and limitations for resection of neoplasms in the anterior cranial fossa and suprasellar region, and to compare this technique with standard craniotomies that are used for excision of those neoplasms. Methods: This prospective comparative study includes forty six patients of different neoplasms in the anterior skull base and supra-sellar region. These patients were operated upon in Ain Shams University hospitals, twenty two of them via lateral supraorbital (fronto-lateral approach) approach through an eyebrow skin incision (the technique of supraorbitalcraniotomy is described in detail in the thesis) and the remaining twenty four via conventional craniotomies (unilateral and bilateral sub-frontal approaches) in the period between February 2010 and May 2013. The selection of surgical approach was according to the surgeon preference. Because of the inhomogeneity of suprasellar lesions and to facilitate comparison, we further classified our patients into two groups: Meningiomas (34 cases) and Non-meningiomas (12 cases). Results: Our statistical results revealed that patients presented with meningiomas who were operated via supraorbital technique had shorter duration of intraoperative exposure of the lesion, less need of ICU admission post-operative and shorter duration of ICU stay (if admitted), less incidence of post-operative seizures, CSF leak, anosmia and forehead disfigurement of the burr holes, however, the incidence of transient impairment of the eye brow movement was higher post the supraorbital approach in comparison with the standard subfrontal approach. There wasn’t any statistical difference between both approaches regarding the extent of the tumor excision, visual outcome post-operative, Glasgow outcome scaleor mortality rate. Conclusion: the supraorbital craniotomy allows a wide, intracranialexposure for extended, bilaterally situated, or even deep-seated intracranial areas, accordingto the strategy of keyhole craniotomies. The supraorbital craniotomy offers equalsurgical possibilities with less approach-related morbidity owing to limited exposure of thecerebral surface and minimal brain retraction. In addition, the short skin incision within theeyebrow and careful soft tissue dissection result in a pleasing cosmetic outcome. Key words: Eyebrow skin incision, Keyhole concept, Minimally invasive neurosurgery, Supraorbital approach.