Supraorbital keyhole approach for suprasellar arachnoid cyst: how I do it

Keyhole approaches have lately sparked strong interest because these approaches address skull base pathologies as reported by Eroglu et al. (World Neurosurg, 2019); Hickmann, Gaida, and Reisch (Acta Neurochir (Wien) 159:881-887, 2017); Jallo and Bognar (Neurosurgery, 2006); and Poblete et al. (J Neurosurg 122:1274-1282, 2015), minimizing brain retraction and improving cosmetic results. We describe the step-by-step surgical technique to drain a suprasellar arachnoid cyst by a supraorbital approach.

The eyebrow incision is a direct route to expose the supraorbital corridor and even if it is smaller than a pterional approach, it permits to open the cisterns and to visualize neurovascular structures. The arachnoid cyst could be safely drained and a T-tube is placed.

This technique represents a suitable option for suprasellar arachnoid cyst, avoiding more extended and invasive approaches.