Translamina Terminalis Approach to the Hypothalamus Using Supraorbital Craniotomy: Technical Note and Comparison with...

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Skull Base Surgery

Background:

• Accessing the hypothalamus and anterior third ventricle presents surgical challenges due to variable approaches.
• Recurrent hemorrhage from hypothalamic cavernomas necessitates effective and safe surgical interventions.

Purpose of the Study:

• To present a technical note on the supraorbital craniotomy via the trans-lamina terminalis approach for hypothalamic lesion access.
• To evaluate the feasibility and efficacy of this minimally invasive corridor for hypothalamic cavernoma resection.

Main Methods:

• Detailed description of the trans-lamina terminalis approach using supraorbital craniotomy, including anatomical landmarks and surgical steps.
• Comparison of the supraorbital corridor with alternative surgical routes to the hypothalamus.
• Case illustration of a patient with a hypothalamic cavernoma undergoing resection via this approach.

Main Results:

• The supraorbital trans-lamina terminalis approach provides effective and safe access to hypothalamic lesions.
• This minimally invasive corridor facilitates gross total resection of lesions while avoiding injury to healthy brain tissue.
• Successful gross total removal of a hypothalamic cavernoma was achieved without causing neurological or endocrinological deficits.

Conclusions:

• Supraorbital craniotomy combined with the trans-lamina terminalis approach is a viable surgical option for hypothalamic lesions.
• Key advantages include minimal brain retraction and a direct end-on surgical view.
• While the corridor is long and narrow, requiring technical familiarity, clinical outcomes are comparable to other surgical methods.