Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision

More than ever before, the priority in contemporary neurosurgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury. The evolution of microsurgical techniques with refined instrumentation and illumination and the enormous development of preoperative and intraoperative diagnostic tools enable neurosurgeons to treat different lesions through limited and specific keyhole approaches.

Based on our surgical experience, the technique of supraorbital subfrontal craniotomy is described in detail in this article. After an eyebrow skin incision is made, a limited supraorbital craniotomy is performed with a width of 15 to 25 mm and a height of 10 to 15 mm.

We have been using the supraorbital keyhole craniotomy since 1985 and have approached a variety of lesions within the anterior, middle, and posterior cranial fossae. During a 10-year period between July 1994 and June 2004, the lesions treated via the supraorbital approach in our department comprised 1125 intracranial tumors or cystic lesions, cerebral aneurysms, and other miscellaneous diseases, performed by 23 different surgeons and residents. Of these 1125 patients, we operated on 471 of them, and information obtained from 450 contributed to the follow-up data. Three months after surgery, the Glasgow Outcome Scale scores for this very heterogeneous group of patients were as follows: 5 in 387 patients (86.0%), 4 in 29 patients (6.4%), 3 in 16 patients (3.5%), 2 in 10 patients (2.2%), and 1 in 8 patients (1.8%). Of the 450 patients, 229 were treated for intracranial aneurysms, 93 for cranial base meningiomas, 39 for craniopharyngiomas, 23 for pituitary adenomas, 18 for deep-seated brainstem tumors, and 48 for other miscellaneous frontotemporal or suprasellar lesions.

In our experience, the supraorbital craniotomy allows a wide, intracranial exposure for extended, bilaterally situated, or even deep-seated intracranial areas, according to the strategy of keyhole craniotomies. The supraorbital craniotomy offers equal surgical possibilities with less approach-related morbidity owing to limited exposure of the cerebral surface and minimal brain retraction. In addition, the short skin incision within the eyebrow and careful soft tissue dissection result in a pleasing cosmetic outcome.