The Lateral Supraorbital Approach: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Skull Base Surgery

Background:

• The pterional approach is a traditional method for accessing anterior circulation aneurysms and sellar/suprasellar tumors.
• Minimally invasive techniques offer potential advantages in reducing surgical morbidity.
• The lateral supraorbital approach (LSO) has emerged as an alternative for specific neurosurgical pathologies.

Purpose of the Study:

• To describe the technical nuances and applications of the lateral supraorbital approach (LSO).
• To highlight the essential steps, anatomical considerations, and potential pitfalls of the LSO.
• To discuss variations and limitations of the LSO in skull base neurosurgery.

Main Methods:

• The LSO involves a skin incision behind the hairline and a small craniotomy.
• A one-layer myocutaneous flap is retracted anteriorly, exposing the superior temporal line and zygomatic process.
• The craniotomy's inferior limit aligns with the Sylvian fissure, providing access to the anterolateral skull base.

Main Results:

• The LSO is suitable for anterior circulation aneurysms (excluding distal ACA), some posterior circulation aneurysms, and sellar/suprasellar tumors.
• Key anatomical landmarks include the superior temporal line and zygomatic process.
• Potential complications include frontal sinus opening, orbital entry, and inadequate exposure, which can be mitigated by careful planning and neuronavigation.

Conclusions:

• The lateral supraorbital approach is a valuable minimally invasive technique for select neurosurgical cases.
• Familiarity with anatomical landmarks and meticulous surgical technique are crucial for successful LSO procedures.
• Variations and extended techniques allow for broader application of the LSO in complex skull base pathologies.