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The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications.
J Neurosurg Pediatr 2015; 15(1):12-9JN

Abstract

OBJECT

The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children-specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications.

METHODS

The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children.

RESULTS

Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%-99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified.

CONCLUSIONS

The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.

Authors+Show Affiliations

Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25396702

Citation

Dlouhy, Brian J., et al. "The Supraorbital Eyebrow Approach in Children: Clinical Outcomes, Cosmetic Results, and Complications." Journal of Neurosurgery. Pediatrics, vol. 15, no. 1, 2015, pp. 12-9.
Dlouhy BJ, Chae MP, Teo C. The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. J Neurosurg Pediatr. 2015;15(1):12-9.
Dlouhy, B. J., Chae, M. P., & Teo, C. (2015). The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. Journal of Neurosurgery. Pediatrics, 15(1), pp. 12-9. doi:10.3171/2014.10.PEDS1430.
Dlouhy BJ, Chae MP, Teo C. The Supraorbital Eyebrow Approach in Children: Clinical Outcomes, Cosmetic Results, and Complications. J Neurosurg Pediatr. 2015;15(1):12-9. PubMed PMID: 25396702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. AU - Dlouhy,Brian J, AU - Chae,Michael P, AU - Teo,Charles, PY - 2014/11/15/entrez PY - 2014/11/15/pubmed PY - 2015/3/17/medline KW - PNET = primitive neuroectodermal tumor KW - complications KW - cosmesis KW - craniopharyngioma KW - eyebrow KW - keyhole KW - minimally invasive surgery KW - neuroendoscopy KW - supraorbital craniotomy KW - technique SP - 12 EP - 9 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 15 IS - 1 N2 - OBJECT: The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children-specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications. METHODS: The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children. RESULTS: Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%-99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified. CONCLUSIONS: The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/25396702/The_supraorbital_eyebrow_approach_in_children:_clinical_outcomes_cosmetic_results_and_complications_ L2 - https://thejns.org/doi/10.3171/2014.10.PEDS1430 DB - PRIME DP - Unbound Medicine ER -