The Supraorbital Eyebrow Craniotomy for Intra- and Extra-Axial Brain Tumors: A Single-Center Series and Technique Modification.

Publication Title

Oper Neurosurg (Hagerstown)

Authors

Shaheryar F Ansari, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Amy Eisenberg, Pacific Neuroscience Institute, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Amanda Rodriguez, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California; John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Garni Barkhoudarian, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California. John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CaliforniaFollow
Daniel F Kelly, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California. John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CaliforniaFollow

Document Type

Article

Publication Date

8-3-2020

Keywords

Brain tumor; Craniopharyngioma; Endoscopy; Glioma; Keyhole approach; Meningioma; Metastasis; Minimally invasive; Outcomes; Supraorbital craniotomy; Supraorbital eyebrow craniotomy

Abstract

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.

Clinical Institute

Neurosciences (Brain & Spine)

Clinical Institute

Cancer

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Oncology