Supraorbital keyhole approach: Lessons learned from 106 operative cases.

Supraorbital keyhole approach: Lessons learned from 106 operative cases.

World Neurosurg. 2019 Jan 16;:

Authors: Eroglu U, Shah K, Bozkurt M, Kahilogullari G, Yakar F, Dogan I, Ozgural O, Attar A, Unlu A, Caglar S, Cohen Gadol AA, Ugur HC

Abstract
OBJECTIVE: The supraorbital keyhole approach through an eyebrow incision has been a potentially less invasive approach as an alternative to the standard pterional craniotomy. We aimed to review procedures for anterior and middle cranial fossa lesions and identify lessons learned from addressing various pathologies through this approach.
METHODS: We retrospectively reviewed 106 consecutive patients who underwent this approach. We documented patients' age, sex, pathology, clinical results, extent of tumor resection, complications, use of endoscope, and cosmetic results.
RESULTS: Our series addressed a variety of pathologies. Males accounted for 55% of the cohort and mean age was 51.7 (2-79) years old. Notably, 52% of patients underwent resection of extra-axial masses. Gross total resection was achieved in 74.4% of intra-axial lesions according to postoperative imaging. Two (1.9%) patients developed transient ptosis. One patient (0.9%) developed an allergic reaction to titanium. No cerebrospinal fluid fistula or rhinorrhea occurred. Three patients developed temporary diabetes insipidus after resection of parasellar lesions (2 craniopharyngiomas and 1 pituitary adenoma). In 14 patients with olfactory groove meningiomas, 6 (42.8%) suffered from absence or diminished olfaction postoperatively, and 2 (14.2%) developed postoperative anosmia. Five (38.5%) patients underwent re-resection of recurrent glial tumors. Four weeks postoperatively, 95% of patients demonstrated acceptable cosmetic results. Cosmetic results for 6 (5%) patients were unavailable.
CONCLUSIONS: The supraorbital keyhole approach may be safely used for various lesions within the anterior and middle cranial fossa. The effectiveness and limitations of this approach and possible complications are discussed. This is a valuable approach for selected patients.

PMID: 30659969 [PubMed - as supplied by publisher]

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