Left Supraorbital Eyebrow Approach for Microscopic Fenestration of a Neuroglial Cyst

Neuroglial cysts (also known as glioependymal cysts) are rare, benign, epithelial-lined cystic lesions that can potentially occur anywhere in the neuraxis. They can be intra, or within, a cranial nerve with the former being more common. The frontal lobe is thought to be the most common location. On magnetic resonance imaging, they follow cerebrospinal fluid signal and have smooth nonenhancing borders. This video demonstrates in a step-by-step fashion the technical nuances of the supraorbital keyhole approach through an eyebrow incision, for fenestration and biopsy of a neuroglial cyst within the left optic tract. The patient was a 27-year-old female who had peripheral vision disturbance postpartum. The cyst on magnetic resonance imaging was initially observed, but follow-up Humphrey visual field testing demonstrated worsening of the partial left superior quadrantanopsia. The keyhole supraorbital approach was selected to provide a direct route to the pathology with minimal soft tissue disruption. The patient was discharged on postoperative day 2 without any complications. Follow-up at 6 weeks demonstrated near-complete resolution of her quadrantanopsia and good cosmesis with no frontalis palsy.