TY - JOUR
T1 - The supraorbital eyebrow craniotomy for intra- And extra-axial brain tumors
T2 - A single-center series and technique modification
AU - Ansari, Shaheryar F.
AU - Eisenberg, Amy
AU - Rodriguez, Amanda
AU - Barkhoudarian, Garni
AU - Kelly, Daniel F.
N1 - Publisher Copyright:
Copyright © 2020 by the Congress of Neurological Surgeons
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: The supraorbital (SO) eyebrow craniotomy provides minimally invasive access to the anterior and middle fossae and parasellar region. OBJECTIVE: To present a series of patients treated with the SO approach to assess outcomes, the impact of endoscopy, and describe a modified pericranial flap aimed at reducing postoperative frontalis paresis and hypesthesia. METHODS: A retrospective analysis was undertaken of our prospective database of patients who underwent SO craniotomy for tumor/cyst removal. Patients were evaluated based on pathology, utility of endoscopy, extent of resection, complications, and functional/esthetic recovery. RESULTS: From 2007 to 2018, 129 operations were performed in 117 patients (54% women; mean age 60 ± 16.5 yr). The most common lesions were meningiomas (43%), gliomas (15%), and metastases (15%). Prior surgery and/or radiation had been performed in 37% and 26% of patients, respectively. Endoscopy was used in 76 (61%) operations and allowed more complete tumor removal in 38 (50%). For first-time operations, gross-total removal was achieved in 78%. Major complications included stroke (3%), cranial nerve deficit (3%), acute hematoma (1%), and cerebrospinal fluid leak (1%). The modified pericranial flap technique used in 18 recent patients resulted in a shorter duration of transient frontalis paresis and forehead hypesthesia with complete functional recovery in all 18. CONCLUSION: The SO craniotomy is an effective keyhole approach for intra- and extra-axial tumors. Endoscopic assistance may allow additional tumor removal in almost 30% of the cases. The modified pericranial flap appears to accelerate functional recovery, although additional patients and follow-up are required to better assess this technique.
AB - BACKGROUND: The supraorbital (SO) eyebrow craniotomy provides minimally invasive access to the anterior and middle fossae and parasellar region. OBJECTIVE: To present a series of patients treated with the SO approach to assess outcomes, the impact of endoscopy, and describe a modified pericranial flap aimed at reducing postoperative frontalis paresis and hypesthesia. METHODS: A retrospective analysis was undertaken of our prospective database of patients who underwent SO craniotomy for tumor/cyst removal. Patients were evaluated based on pathology, utility of endoscopy, extent of resection, complications, and functional/esthetic recovery. RESULTS: From 2007 to 2018, 129 operations were performed in 117 patients (54% women; mean age 60 ± 16.5 yr). The most common lesions were meningiomas (43%), gliomas (15%), and metastases (15%). Prior surgery and/or radiation had been performed in 37% and 26% of patients, respectively. Endoscopy was used in 76 (61%) operations and allowed more complete tumor removal in 38 (50%). For first-time operations, gross-total removal was achieved in 78%. Major complications included stroke (3%), cranial nerve deficit (3%), acute hematoma (1%), and cerebrospinal fluid leak (1%). The modified pericranial flap technique used in 18 recent patients resulted in a shorter duration of transient frontalis paresis and forehead hypesthesia with complete functional recovery in all 18. CONCLUSION: The SO craniotomy is an effective keyhole approach for intra- and extra-axial tumors. Endoscopic assistance may allow additional tumor removal in almost 30% of the cases. The modified pericranial flap appears to accelerate functional recovery, although additional patients and follow-up are required to better assess this technique.
KW - Brain tumor
KW - Craniopharyngioma
KW - Endoscopy
KW - Glioma
KW - Keyhole approach
KW - Meningioma
KW - Metastasis
KW - Minimally invasive
KW - Outcomes
KW - Supraorbital craniotomy
KW - Supraorbital eyebrow craniotomy
UR - http://www.scopus.com/inward/record.url?scp=85089830976&partnerID=8YFLogxK
U2 - 10.1093/ons/opaa217
DO - 10.1093/ons/opaa217
M3 - Article
C2 - 32745195
AN - SCOPUS:85089830976
SN - 2332-4252
VL - 19
SP - 667
EP - 677
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 6
ER -