Supraorbital Keyhole Approach: Lessons Learned from 106 Operative Cases

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Cranial Base Surgery

Background:

• The supraorbital keyhole approach offers a less invasive alternative to traditional pterional craniotomy for accessing anterior and middle cranial fossa lesions.
• This approach utilizes an eyebrow incision for improved cosmesis and reduced surgical trauma.

Purpose of the Study:

• To review the application of the supraorbital keyhole approach for various anterior and middle cranial fossa pathologies.
• To identify the efficacy, limitations, and potential complications associated with this surgical technique.

Main Methods:

• Retrospective review of 106 consecutive patients undergoing the supraorbital keyhole approach.
• Data collected included patient demographics, pathology, clinical outcomes, extent of resection, complications, endoscopic use, and cosmetic results.

Main Results:

• The study included 106 patients (55% male, mean age 51.7 years) with diverse pathologies, including 52% extra-axial masses.
• Gross total resection was achieved in 74.4% of intra-axial lesions. Complications were infrequent, with transient ptosis in 1.9% and temporary diabetes insipidus in 2.8% for specific lesions.
• Excellent cosmetic results were reported in 95% of patients at 4 weeks postoperatively.

Conclusions:

• The supraorbital keyhole approach is a safe and effective method for treating selected anterior and middle cranial fossa lesions.
• This technique provides a valuable option with good functional and cosmetic outcomes for carefully selected patients.
• Understanding the approach's limitations and potential complications is crucial for successful application.