The trans-eyebrow supraorbital approach for removal of anterior cranial fossa and suprasellar meningiomas

Close metadata

Recommended articles:

Bacterial contamination of autologous blood in reinfusion in neurosurgery: a phenomenon or a problem?. Burdenko's Journal of Neurosurgery. 2024;(2):54-61

Accessory nerve meningioma. A case report and literature review. Burdenko's Journal of Neurosurgery. 2024;(3):90-95

En plaque convexity hyperostotic meningioma: 69 cases from a singlecenter. Burdenko's Journal of Neurosurgery. 2025;(1):20-29

Experimental substantiation of the original minimally invasive access for surgical correction of diastasis of rectus abdominis muscles. Plastic Surgery and Aesthetic Medicine. 2024;(3):99-104

Over the past two decades, improvements in surgical tools, navigation systems, and endoscopic techniques have resulted in the widespread use of keyhole surgery for a wide range of skull base tumors. Currently, the trans-eyebrow supraorbital approach is being increasingly used in surgery for anterior cranial fossa and parasellar tumors. Material and methods. The study included 7 patients who underwent surgery for meningioma using the trans-eyebrow supraorbital approach at the Burdenko Neurosurgical Institute in the period between 2013 and 2017. The age of patients ranged from 51 to 75 years (median, 60 years); there were 5 females and 2 males. The maximum diameter of resected tumors ranged from 20 to 60 mm (median 40 mm). Results. Total resection of the tumor was achieved in all 7 cases, which was confirmed by postoperative MRI control. All 7 patients had a good cosmetic result. In 1 case, there was postoperative cerebrospinal fluid rhinorrhea due to incomplete closure of the frontal sinus, which required the patient to be re-operated. None of 7 cases was associated with injury to the main vessels or cavernous sinus. Conclusion. Supraorbital trans-eyebrow craniotomy provides a minimally invasive approach for removing most anterior cranial fossa base and suprasellar tumors. The advantages of keyhole surgery, in comparison with traditional craniotomies, are minimal complications associated with the approach.

Keywords:

meningioma

keyhole surgery

surgical approach

Authors:

Pitskhelauri D.I.

Burdenko Neurosurgical Center

SPIN RSCI: 3261-2144
Scopus AuthorID: 6507820245
ORCID: 0000-0003-0374-7970

Sanikidze A.Z.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

Abramov I.T.

Burdenko Neurosurgical Institute, Moscow, Russia

Moshchev D.A.

Burdenko National Research Center of Neurosurgery of the Ministry of Health of the Russia, Moscow, Russia

Anan’ev E.P.

Burdenko Neurosurgical Institute, Moscow, Russia

Eliseeva N.M.

NII neĭrokhirurgii im. akad. N.N. Burdenko RAMN, Moskva

Bykanov A.E.

FGBU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva

List of references:

Cook SW, Smith Z, Kelly DF. Endonasal transsphenoidal removal of tuberculum sellae meningiomas: technical note. Neurosurgery. 2004;55:239-244.
Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery. 2004:55:539-547.
Czirjak S, Seifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery. 2001;48:145-150.
Czirjak S, Seifert GT. The role of the superciliary approach in the surgical management of intracranial neoplasms. Neurol Res. 2006;28:131-137. https://doi.org/10.1179/016164106X97991
de Divitiis E, Cavallo LM, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2. Neurosurgery. 2007;60:46-58. https://doi.org/10.1227/01.NEU.0000249211.89096.25
de Divitiis E, Cavallo LM, Esposito F, Stella L, Messina A. Extended endoscopic transsphenoidal approach for tuberculum sella meningiomas. Neurosurgery. 2007;61(5):229-238. https://doi.org/10.3171/jns.2005.102.5.0832
Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin NA. The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg. 2005;102:832-841. https://doi.org/10.3171/jns.2005.102.5.0832
Fernandes YB, Maitrot D, Kehrli Р, Tella OIJr, Ramina R, Borges G. Supraorbital eyebrow approach to skull base lesions. Arq Neuropsiquiatr. 2002;60:246-250.
Jane JA, Dumont AS, Lee M. Vance: the transsphenoidal transtuberculum sellae approach for suprasellar meningiomas. Semin Neurosurg. 2003;14(3): 211-218.
Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 1-The midline anterior fossa skull base. Minim Invasive Neurosurg.2004;47:1-8. https://doi.org/10.1055/s-2003-812538
Joseph V, Chacko AG. Suprabrow minicraniotomy for suprasellar tumours. Br J Neurosurg. 2005;19:33-37. https://doi.org/10.1080/02688690500089415
Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg. 1997;40:91-97. https://doi.org/10.1055/s-2008-1053424
Kitano M, Taneda M. Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg. 2001;94:999-1004. https://doi.org/10.3171/jns.2001.94.6.0999
Kitano M, Taneda M, Nakao Y. Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. J Neurosurg. 2007;107:337-346. https://doi.org/10.3171/JNS-07/08/0337
Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. 2007;106:400-406. https://doi.org/10.3171/jns.2007.106.3.400
Laws ER, Kanter AS, Jane JAJr, Dumont AS. Extended transsphenoidal approach. J Neurosurg. 2005;102:825-827. https://doi.org/10.3171/jns.2005.102.5.0825
Melamed I, Merkin V, Korn A, Nash V, et al. The supraorbital approach: an alternative to traditional exposure for the surgical management of anterior fossa and parasellar pathology. Minim Invasive Neurosurg. 2005;48:259-263. https://doi.org/10.1055/w-2005-915603
Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery. 2005;57:242-255.
Shanno G, Maus M, Bilyk J, Schwartz S, Savino P, Simeone F, Goldman HW. Image-guided transorbital roof craniotomy via a suprabrow approach: a surgical series of 72 patients. Neurosurgery. 2001;48:559-567.
Wiedemayer H, Sandalcioglu IE, Wiedemayer H, Stolke D. The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base. Minim Invasive Neurosurg. 2004;47:221-225. https://doi.org/10.1055/s-2004-818526
Wilson DH. Limited exposure in cerebral surgery. Technical note. J Neurosurg. 1971;34:102-106. https://doi.org/10.3171/jns.1971.34.1.0102
Perneczky A, Muller-Forell E, Van Lindert W, Fries G. Keyhole Concept in Neurosurgery: with Endoscopic-Assisted Microneurosurgery and Case Studies. 1999.
Yasargil MG, Fox JL. The microsurgical approach to intracranial aneurysms. Surg Neurol. 1975 Jan;3(1):7-14.
Fox JL. Microsurgical exposure of intracranial aneurysms. J Microsurg. 1979 Jul-Aug;1(1):2-31.Fox J.L
Welling LC, Figueiredo EG, Wen HT, Gomes MQ, Bor-Seng-Shu E, Casarolli C, Guirado VM, Teixeira MJ. Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic peritonal craniotomies. J Neurosurg. 2015 May;122(5):1012-1019. https://doi.org/10.3171/2014.11.JNS146
Perneczky A, Muller-Forell W, Van Lindert E, Fries G. Keyhole Concept in Neurosurgery: with Endoscopic-Assisted Microneurosurgery and Case Studies.1999.
van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol. 1998 May;49(5):481-489.
Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg. 2014 Dec;82(6 Suppl):S72-S80. https://doi.org/10.1016/j.wneu.2014.07.029
Dlouhy BJ, Chae MP, Teo C. The supraorbital eyebrow approach in children: clinical outcomes, cosmetic results, and complications. Journal of neurosurgery. 2015;15(1):12-19.
Thaher F, Hopf N, Hickmann AK, Kurucz P, Bittl M, Henkes H, Feigl G. Supraorbital keyhole approach to the skull base: evaluation of complications related to CSF fistulas and opened frontal sinus. J Neurol Surg A Cent Eur Neurosurg. 2015 Nov;76(6):433-437. https://doi.org/10.1055/s-0034-1389368
Reisch R, Fischer G, Stadie A, Kockro R, Cesnulis E, Hopf N. The supraorbital endoscopic approach for aneurysms. World Neurosurg. 2014 Dec;82(6 Suppl):S130-S137. https://doi.org/10.1016/j.wneu.2014.07.038
Fischer G, Stadie A, Reisch R, Hopf NJ, Fries G, Böcher-Schwarz H, van Lindert E, Ungersböck K, Knosp E, Oertel J, Perneczky A. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery. 2011 Mar;68(1 Suppl Operative):45-51; discussion 51. https://doi.org/10.1227/NEU.0b013e31820934ca
Warren WL, Grant GA. Transciliary orbitofrontozygomatic approach to lesions of the anterior cranial fossa. Neurosurgery. 2009 May;64(5 Suppl 2):324-329; discussion 329-330. https://doi.org/10.1227/01.NEU.0000338951.29171.07
Paladino J, Mrak G, Miklić P, Jednacak H, Mihaljević D. The keyhole concept in aneurysm surgery — a comparative study: keyhole versus standardcraniotomy. Minim Invasive Neurosurg. 2005 Oct;48(5):251-258. https://doi.org/10.1055/s-2005-915599
Czirják S, Nyáry I, Futó J, Szeifert GT. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol. 2002 May;57(5):314-323.
Reisch R, Marcus HJ, Hugelshofer M, Koechlin NO, Stadie A, Kockro RA. Patients’ cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision. J Neurosurg. 2014; 121(3):730-734.
Gazzeri R, Nishiyama Y, Teo C. Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. Neurosurg Focus. 2014;37(4):E20.
Kazkayasi M, Batay F, Bademci G, Bengi O, Tekdemir I. The morphometric and cephalometric study of anterior cranial landmarks for surgery. Minim Invasive Neurosurg. 2008 Feb;51(1):21-25. https://doi.org/10.1055/s-2007-1022541
Andersen NB, Bovim G, Sjaastad O. The frontotemporal peripheral nerves. Topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23(2):97-104.
Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg. 2013;2013:296469. https://doi.org/10.1155/2013/296469
Zador Z, Coope DJ, Gnanalingham K, Lawton MT. Quantifying surgical access in eyebrow craniotomy with and without orbital bar removal: cadaver and surgical phantom studies. Acta Neurochir (Wien). 2014;156(4):697-702; discussion 702.
Figueiredo EG, Deshmukh V, Nakaji P, Deshmukh P, Crusius MU, Crawford N, Spetzler RF, Preul MC. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery. 2006;59.
Steiger HJ, Schmid-Elsaesser R, Stummer W, Uhl E. Transorbital keyhole approach to anterior communicating artery aneurysms. Neurosurgery. 2001;48(2):347-351; discussion 342-351.
Pitskhelauri DI, Konovalov AN, Shekutev GA, Rojnin NB, Kachkov IA, Samborskiy DY, Sanikidze AZ, Kopachev DN. A novel device for hands-free positioning and adjustment of the surgical microscope. J Neurosurg. 2014 Jul;121(1):161-164. https://doi.org/10.3171/2014.3.JNS12578
Kallio M, Sankila L, Hakulien T, Jaaskilainen J. Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningeoma. Neurosurgery. 1992;31:2-12.
Rubin G, David UB, Gornish M, Rappaport ZH. Meningeomas of the anterior cranial floor: review of 67 cases. Acta Neurochir (Wien). 1994;129:26-30.
Solero CL, Giombini S, Morello G. Suprasellar and olfactory meningioma. report of a series of 153 personal cases. Acta Neurochir (Wien). 1993;67:181-194.
Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus. 2003.
Obeid F, Al-Mefty O. Recurrence of olfactory groove meningioma. Neurosurgery. 2003;53:534-543.
Turazzi S, Cristofori L, Gambini R, Bricolo A. The pterional approach for microsurgical removal of olfactory groove meningioma. Neurosurgery. 1999;45:821-826.
Al-efty О, Holoubi А, Rifai А, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery. 1985;16:364-372.
Andrews BT, Wilson CB. Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome. J Neurosurg. 1988;69:523-528. https://doi.org/10.3171/jns.1988.69.4.0523
Fahlbusch R, Schott W. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg. 2002;96:235-243. https://doi.org/10.10.3171/jns.2002.96.2.0235
Mathiesen T, Kihlstrom L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery. 2006;59:570-576. https://doi.org/10.1227/01.NEU.0000228683.79123.F9
Jallo GI, Benjamin V. Tuberculum sellae meningiomas: microsurgical outcome and surgical technique. Neurosurgery. 2002;51:1432-1440.
Cushing Н, Eisenhardt L. Suprasellar meningiomas. The chiasmal syndrome. Meningiomas: their Classification, Regional Behavior, Life History and Surgical End Results. 1938.
Black Р. Aggressive surgery and focal radiotherapy in the management of meningiomas of the skull base: preservation of function with maintenance of local control. Acta Neurochir (Wien). 2001;143:555-562.
Goel А, Muzumdar D, Desai KI. Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery. 2002;51:1358-1363.
Jallo GI, Benjamin V. Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery. 2002;51:1432-1439.
Nakamura M, Roser F, Struck M, Vorkapic P, Samii M.Tuberculum sellae meningioma: clinical outcome considering different surgical approaches. Neurosurgery. 2006;59:1019-1029.
Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory groove meningioma: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery. 2007; 60(5):844-852. https://doi.org/10.1227/01.NEU.0000255453.20602.80
Otani N, Muroi С, Yano Н, Khan N, Pangalu A, Yonekawa Y. Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy. Br J Neurosurg. 2006;20:129-138. https://doi.org/10.1227/01.NEU.0000255453.20602.80
Park CK, Jung HW, Yang SY, Seol HJ, Paek SH, Kim DG. Surgically treated tuberculum sellae and diaphragm sellae meningiomas: the importance of short-term visual outcome. Neurosurgery. 2006;59:238-243. https://doi.org/10.1227/01.NEU.0000223341.08402.C5
Spektor S, Valarezo J, Fliss D. Olfactory groove meningiomas from neurosurgical and ear, nose and throat perspectives. Approaches, techniques and outcomes. Neurosurgery. 2005;57(4):268-280.
Mathiesen T, Lindquist C, Kihlstrom L, Karlsson B. Recurrence of cranial base meningiomas. Neurosurgery. 1996 Jul;39(1):2-7.
Mirimanoff RO, Linggood RM, Ojeman R, Martuza R. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62:18-24. https://doi.org/10.3171/jns.1985.62.1.0018

Close metadata