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Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors.
Neurosurg Focus 2014; 37(4):E20NF

Abstract

OBJECT

The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the anterior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity.

METHODS

All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retrospectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results.

RESULTS

During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow approach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscellaneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1-8 days). In 82 patients a total removal of the lesion was performed, while in 15 patients a near-total or subtotal removal was achieved. There were no postoperative hematomas, cerebrospinal fluid leaks, or severe neurological deficits, with the exception of 2 cases of visual deterioration and 1 case each of meningitis, stroke, and third cranial nerve paresis. Other complications directly related to the approach included 2 cases of skin burn as a direct result of heat transmission from the microscope light, 1 case of right frontal palsy, 2 cases of frontal numbness, and 1 case of bone remodeling 1 year after surgery.

CONCLUSIONS

The endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive approach to remove extra- and intraaxial anterior skull base, parasellar, and frontal lesions, promoting a rapid recovery and short hospital stay. The location of the eyebrow incision demands a meticulous cosmetic closure, but, with proper technique, cosmetic results are excellent.

Authors+Show Affiliations

Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25270140

Citation

Gazzeri, Roberto, et al. "Endoscopic Supraorbital Eyebrow Approach for the Surgical Treatment of Extraaxialand Intraaxial Tumors." Neurosurgical Focus, vol. 37, no. 4, 2014, pp. E20.
Gazzeri R, Nishiyama Y, Teo C. Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. Neurosurg Focus. 2014;37(4):E20.
Gazzeri, R., Nishiyama, Y., & Teo, C. (2014). Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. Neurosurgical Focus, 37(4), pp. E20. doi:10.3171/2014.7.FOCUS14203.
Gazzeri R, Nishiyama Y, Teo C. Endoscopic Supraorbital Eyebrow Approach for the Surgical Treatment of Extraaxialand Intraaxial Tumors. Neurosurg Focus. 2014;37(4):E20. PubMed PMID: 25270140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. AU - Gazzeri,Roberto, AU - Nishiyama,Yuya, AU - Teo,Charles, PY - 2014/10/2/entrez PY - 2014/10/2/pubmed PY - 2015/6/3/medline KW - DNET = dysembryoplastic neuroepithelial tumor KW - VASC = visual analog scale for cosmesis KW - brain tumor KW - craniopharyngioma KW - endoscopy KW - eyebrow approach KW - meningioma KW - subfrontal craniotomy KW - supraorbital approach SP - E20 EP - E20 JF - Neurosurgical focus JO - Neurosurg Focus VL - 37 IS - 4 N2 - OBJECT: The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the anterior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity. METHODS: All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retrospectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results. RESULTS: During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow approach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscellaneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1-8 days). In 82 patients a total removal of the lesion was performed, while in 15 patients a near-total or subtotal removal was achieved. There were no postoperative hematomas, cerebrospinal fluid leaks, or severe neurological deficits, with the exception of 2 cases of visual deterioration and 1 case each of meningitis, stroke, and third cranial nerve paresis. Other complications directly related to the approach included 2 cases of skin burn as a direct result of heat transmission from the microscope light, 1 case of right frontal palsy, 2 cases of frontal numbness, and 1 case of bone remodeling 1 year after surgery. CONCLUSIONS: The endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive approach to remove extra- and intraaxial anterior skull base, parasellar, and frontal lesions, promoting a rapid recovery and short hospital stay. The location of the eyebrow incision demands a meticulous cosmetic closure, but, with proper technique, cosmetic results are excellent. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/25270140/Endoscopic_supraorbital_eyebrow_approach_for_the_surgical_treatment_of_extraaxialand_intraaxial_tumors_ L2 - https://thejns.org/doi/10.3171/2014.7.FOCUS14203 DB - PRIME DP - Unbound Medicine ER -