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Published on: August 11, 2015
The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution
S M Raza1, T Garzon-Muvdi, K Boaehene
1The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Introduction:
The supraorbital craniotomy was initially described as a minimally invasive means to target extra-axial lesions in the anterior cranial fossa and sellar/parasellar region. Since its initial description, various modifications have been described. We report our recent experience with this approach (and its modifications) for not only extra-axial but also intra-axial neoplastic pathology.
Methods:
Based on patient pathology and anatomic considerations, one of two approaches was performed: supraorbital craniotomy through an eyebrow incision or a combined orbital osteotomy and supraorbital craniotomy through an eyelid incision.
Results:
This technique was performed on twenty-eight consecutive patients. Intra-axial pathology ranged from anaplastic astrocytoma to metastasis while extra-axial lesions included meningiomas and skull-based metastases. Excellent lesion resection was achieved in the majority of patients. Complications were infection (2 patients) and CSF leak.
Discussion:
The supraorbital craniotomy and its modifications provide an ideal anterior subfrontal approach through which a wide variety of pathology can be approached. This technique has particular considerations in comparison to traditional cranial base approaches that must be taken into account before it is utilized.
