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Bilateral Traumatic Frontal Hematoma Evacuation Using the Supraorbital Keyhole Approach: A Case Report Elucidating
Alex Michel Daoud1, Lorenna Filice1, Jean Gonçalves De Oliveira1
1Neurological Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, BRA.
Cureus
|August 28, 2025
Summary
Bilateral frontal contusions are a neurosurgical emergency. The supraorbital keyhole approach (SOKA) offers a minimally invasive option for evacuating these traumatic hematomas, improving patient outcomes.
Area of Science:
- Neurosurgery
- Traumatic Brain Injury
Background:
- Bilateral frontal contusions post-traumatic brain injury (TBI) pose a significant neurosurgical risk, often leading to intracranial hypertension and herniation.
- Conventional craniotomies for extensive hematomas carry risks of surgical trauma, extended recovery, and poor cosmetic results.
Observation:
- The supraorbital keyhole approach (SOKA), a minimally invasive technique, is typically used for anterior cranial fossa lesions.
- Its application in extensive bilateral traumatic hematomas is not well-documented.
Findings:
- A 36-year-old male with bilateral frontal intraparenchymal hematomas underwent successful evacuation using bilateral supraorbital craniotomies via eyebrow incisions.
- The procedure achieved near-total hematoma evacuation with minimal brain retraction and no neurovascular injury.
Implications:
- This case highlights the feasibility and safety of the bilateral SOKA for managing traumatic brain hematomas.
- The supraorbital keyhole approach may serve as a viable alternative to traditional craniotomies in selected neurotrauma cases, offering improved recovery and aesthetic benefits.
