The Transciliary Supraorbital Keyhole Approach for Different Intracranial Pathologies: Lessons Learned After the...

To evaluate the safety, efficacy, and feasibility of the transciliary supraorbital keyhole (TSK) approach for a range of intracranial pathologies in a general neurosurgical department.

Between 2009 and 2021, 50 patients underwent the TSK approach for various intracranial pathologies performed by 11 surgeons at the Department of Neurosurgery, Oslo University Hospital-Ullevaal. We assessed surgical efficacy, complication rates, and length of postoperative hospital stay. An independent physician, not involved in the surgical procedures or patient selection, reviewed data obtained from operative reports, follow-up notes, and magnetic resonance imaging scans.

The study included 50 patients (median age 59 years; 50% female). Among them, 43 had intracranial tumors and 7 had head trauma. Tumor patients were divided into two groups; tumor resection (n = 40) and tumor biopsy (n = 3). In the resection group, gross total resection was achieved in 75% of the patients. The mean resection grades for meningiomas, gliomas, metastases, and epidermoid tumors were 97%, 70%, 92%, and 96%, respectively. Surgical goals were met in all biopsy and head trauma cases. Eleven patients had low-grade complications (Landriel Ibañez grade I or II), and no severe complications (grade III or IV) were reported. The median postoperative hospital stay was 3 days for tumor patients and 7 days for head trauma patients.

The TSK approach is a safe and effective method for various intracranial pathologies, even when performed in a general neurosurgical department by multiple surgeons.