Available online 23 January 2013
Publication year: 2013
Source:World Neurosurgery
Objective The supraorbital (SO) "eyebrow" craniotomy is commonly used to remove extra-axial frontal fossa and parasellar tumors such as meningiomas and craniopharyngiomas. Herein we present the utility and selection criteria for the SO approach to resect intra-axial frontal brain lesions. Methods All consecutive patients who underwent a SO craniotomy for an intra-axial lesion were retrospectively analyzed for lesion location, pathology, extent of resection, operative times, length of stay and complications. Results Over 28 months, 10 patients (mean age 67.6 years, 7 female) underwent 11 SO procedures to resect intra-axial brain lesions. Pathology included metastatic carcinoma (n=7), glioma (n=2) and radiation necrosis (n=1). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near total removal was achieved in 80% of the cases. Median length of hospital stay was 3 days (range 2 – 6 days), and was 2 days for patients admitted electively for SO craniotomy. There were no new neurological deficits, post-operative hematomas or CSF leaks. Conclusion The SO "eyebrow" craniotomy is a safe and effective keyhole method to remove intra-axial frontal lobe lesions, particularly those of the frontal pole and orbito-frontal region, allowing for minimal disruption of normal brain parenchyma, and promoting a rapid recovery and relatively short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intra-axial tumors can also be effectively accessed via this route with excellent clinical outcomes.
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