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The supraorbital approach to the basal frontal lobe for resection of brain metastasis.

Abstract

This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change who was noted to have a large left frontal mass. The patient had a history of melanoma, and pathological analysis of the intracranial lesion was consistent with metastatic melanoma. The patient underwent an uneventful gross-total lesion resection. The step-by-step techniques for performing this operation are illustrated. Although not used in this case because we had an excellent view of the lesion, removal of the orbital rim allows the surgeon to obtain a better inferior-to-superior trajectory without using retraction. Of utmost importance to satisfactory cosmetic outcome are meticulous layer-by-layer closure of the eyebrow incision and maintaining pressure on the wound at the time of extubation. This pressure prevents accumulation of hematoma or cerebrospinal fluid, which places the wound under tension, impedes healing, and detrimentally affects cosmetic outcome. Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication.

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  • Authors+Show Affiliations

    ,

    Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. Electronic address: neuropub@hsc.utah.edu.

    Department of Neurosurgery, University of Virginia Charlottesville, Virginia.

    Source

    World neurosurgery : 2019 Jun 14 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31207369

    Citation

    Menacho, Sarah T., and M Yashar S. Kalani. "The Supraorbital Approach to the Basal Frontal Lobe for Resection of Brain Metastasis." World Neurosurgery, 2019.
    Menacho ST, Kalani MYS. The supraorbital approach to the basal frontal lobe for resection of brain metastasis. World Neurosurg. 2019.
    Menacho, S. T., & Kalani, M. Y. S. (2019). The supraorbital approach to the basal frontal lobe for resection of brain metastasis. World Neurosurgery, doi:10.1016/j.wneu.2019.06.047.
    Menacho ST, Kalani MYS. The Supraorbital Approach to the Basal Frontal Lobe for Resection of Brain Metastasis. World Neurosurg. 2019 Jun 14; PubMed PMID: 31207369.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The supraorbital approach to the basal frontal lobe for resection of brain metastasis. AU - Menacho,Sarah T, AU - Kalani,M Yashar S, Y1 - 2019/06/14/ PY - 2019/03/21/received PY - 2019/06/05/revised PY - 2019/06/06/accepted PY - 2019/6/18/entrez PY - 2019/6/18/pubmed PY - 2019/6/18/medline KW - basal frontal lobe KW - eyebrow craniotomy KW - metastasis KW - supraorbital approach KW - surgery JF - World neurosurgery JO - World Neurosurg N2 - This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change who was noted to have a large left frontal mass. The patient had a history of melanoma, and pathological analysis of the intracranial lesion was consistent with metastatic melanoma. The patient underwent an uneventful gross-total lesion resection. The step-by-step techniques for performing this operation are illustrated. Although not used in this case because we had an excellent view of the lesion, removal of the orbital rim allows the surgeon to obtain a better inferior-to-superior trajectory without using retraction. Of utmost importance to satisfactory cosmetic outcome are meticulous layer-by-layer closure of the eyebrow incision and maintaining pressure on the wound at the time of extubation. This pressure prevents accumulation of hematoma or cerebrospinal fluid, which places the wound under tension, impedes healing, and detrimentally affects cosmetic outcome. Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31207369/The_supraorbital_approach_to_the_basal_frontal_lobe_for_resection_of_brain_metastasis L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31588-8 DB - PRIME DP - Unbound Medicine ER -