TRANSCILIARY ORBITOFRONTOZYGOMATIC APPROACH TO LESIONS OF THE ANTERIOR CRANIAL FOSSA

Abstract OBJECTIVE Several variations on the supraorbital craniotomy via a forehead or eyebrow incision have been described in the literature in recent years. A modification of this approach, the transciliary orbitofrontozygomatic approach, has been used by the authors as a minimally invasive method of approaching certain intracranial pathologies. The authors present their experience with this technique in 105 consecutive patients with tumors or aneurysms of the anterior cranial fossa. METHODS A transciliary keyhole approach was used in all cases. From June 1998 to June 2005, 37 tumors, 1 cavernous malformation, and 77 anterior circulation aneurysms were treated (67 females, 38 males; age range, 8–77 years) with an orbitofrontozygomatic approach via an eyebrow incision. Patients were followed by the authors at a single institution for 1 year postoperatively. RESULTS Of the 105 patients treated with a transciliary orbitofrontozygomatic approach, 2 (1.9%) developed a cerebrospinal leak. Two other patients (1.9%) very early in the series had persistent forehead asymmetry at 1 year postoperatively. Two patients who underwent surgery for a ruptured aneurysm experienced an intraoperative rupture, which was thought to be unrelated to the exposure. None of the operations had to be converted to a pterional craniotomy. CONCLUSION This approach was used in 105 consecutive patients who underwent operation for either tumors or aneurysms via an eyebrow incision. The transciliary orbitofrontozygomatic approach is associated with low surgical morbidity. Although experience with this technique is still limited, it is a viable alternative in cases in which the pathology resides in the midline or anterior fossa.

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Eyelid approach to the anterior cranial base

Journal of Neurosurgery ◽

10.3171/jns/2008/109/8/0341 ◽

2008 ◽

Vol 109 (2) ◽

pp. 341-346 ◽

Cited By ~ 40

Author(s):

Norberto Andaluz ◽

Alberto Romano ◽

Likith V. Reddy ◽

Mario Zuccarello

Keyword(s):

Minimally Invasive ◽

Skull Base ◽

Artery Aneurysm ◽

Anterior Cranial Fossa ◽

Anterior Communicating Artery ◽

Surgical Morbidity ◽

Anterior Circulation ◽

Unruptured Aneurysms ◽

Anterior Cranial Base ◽

Cranial Fossa

Skull base approaches play a fundamental role in modern neurosurgery by reducing surgical morbidity. Increasing experience has allowed surgeons to perform minimally invasive approaches without straying from the premises of skull base surgery. The eyelid approach has evolved from the orbitopterional osteotomy into a more effective and targeted approach to disease of the anterior cranial fossa. In this technique, after an incision is made on the supratarsal fold, the orbicularis oculi muscle is incised, and a myocutaneous flap composed of the elements of the anterior lamella is elevated. Subperiosteal dissection is used to expose the superior and lateral walls of the orbit, the superior and lateral orbital rim, and the frontosphenoidal suture. A MacCarty bur hole is drilled, and a frontal osteotomy is fashioned medial to the supraorbital notch and extending through the orbital roof back toward the orbital half of the MacCarty bur hole, exposing the frontobasal brain. A conventional microsurgical technique is used to treat tumors and aneurysms of the anterior cranial fossa under the operative microscope. Five patients were treated for unruptured aneurysms of the anterior circulation (3 anterior communicating artery aneurysms, 1 ophthalmic artery aneurysm, and 1 posterior communicating artery aneurysm) using the eyelid approach. The mean aneurysm size was 5 mm, and all aneurysms were approached from the right side. Three tumors in the anterior fossa (2 suprasellar pituitary adenomas and 1 craniopharyngioma) were also excised using this approach. There was no surgical morbidity. Three months after surgery all patients presented excellent cosmetic results. The eyelid approach may be considered as an effective, cosmetically beneficial, and minimally invasive skull base approach to selected aneurysms and tumors of the anterior circulation.

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Temporalis myofascial repair of traumatic defects of the anterior fossa

Journal of Neurosurgery ◽

10.3171/jns.1986.64.6.0977 ◽

1986 ◽

Vol 64 (6) ◽

pp. 977-978 ◽

Cited By ~ 11

Author(s):

Ritchie P. Gillespie ◽

Frank W. Shagets ◽

Raul A. de los Reyes

Keyword(s):

Bone Defects ◽

Anterior Cranial Fossa ◽

Content Type ◽

Anterior Fossa ◽

Cranial Fossa ◽

Dural Defects ◽

Fine Print

✓ Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

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Supraorbital Keyhole Approach for Anterior Cranial Fossa Meningiomas

Skull Base ◽

10.1055/s-2009-1222161 ◽

2009 ◽

Vol 19 (01) ◽

Author(s):

Ali Ayyad

Keyword(s):

Anterior Cranial Fossa ◽

Cranial Fossa ◽

Keyhole Approach

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Transarterial embolization of an anterior fossa cranial base dural arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2014.v2.focus14174 ◽

2014 ◽

Vol 37 (v1supplement) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Brian Lee ◽

Vivek A. Mehta ◽

Arun P. Amar ◽

Matthew S. Tenser ◽

William J. Mack

Keyword(s):

Ophthalmic Artery ◽

Transarterial Embolization ◽

Cranial Base ◽

Anterior Cranial Fossa ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Endovascular Approach ◽

Anterior Fossa ◽

Cranial Fossa ◽

Embolic Materials

Open surgical disconnection has long been the treatment of choice for dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa. However, advanced patient age and the presence of medical comorbidities can substantially increase the risk of craniotomy and favor a less invasive endovascular approach. Optimal positioning within the distal ophthalmic artery, beyond the origin of the central retinal branch, is achievable using current microcatheter technology and embolic materials. Here we present the case of an 88-year-old female with an incidentally discovered dAVF of the anterior cranial fossa. Angiographic cure was achieved with one-stage Onyx embolization.The video can be found here: http://youtu.be/KVE0fUIECQM.

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Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx

Interventional Neuroradiology ◽

10.1177/159101990801400407 ◽

2008 ◽

Vol 14 (4) ◽

pp. 415-427 ◽

Cited By ~ 10

Author(s):

Xianli Lv ◽

Chuhan Jiang ◽

Youxiang Li ◽

Xinjian Yang ◽

Zhongxue Wu

Keyword(s):

Cavernous Sinus ◽

Clinical Results ◽

Sigmoid Sinus ◽

Anterior Cranial Fossa ◽

Transvenous Embolization ◽

Arteriovenous Fistulas ◽

Detachable Coils ◽

Cranial Fossa ◽

Age Range

This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization. Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11–70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome. Data for 23 patients (age range, 11–70 yrs, mean age 49.5 yrs) with DAVFs (cavernous sinus[CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment. The mean clinical follow-up period was 22.1 months. Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs.

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How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1727301 ◽

2021 ◽

Author(s):

Sivashanmugam Dhandapani ◽

Rajasekhar Narayanan ◽

Manju Dhandapani ◽

Hemant Bhagat

Keyword(s):

Surgical Outcome ◽

Delayed Cerebral Ischemia ◽

Anterior Communicating Artery ◽

Parent Vessel ◽

Anterior Circulation ◽

Lumbar Drain ◽

Significant Difference ◽

Keyhole Approach ◽

Intraoperative Rupture ◽

Anterior Circulation Aneurysms

Abstract Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication.

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Fully endoscopic transcranial removal of anterior fossa meningioma through the minipterional keyhole approach in case with marked frontal sinuous pneumatization: clinical case

Russian journal of neurosurgery ◽

10.17650/1683-3295-2021-23-2-103-111 ◽

2021 ◽

Vol 23 (2) ◽

pp. 103-111

Author(s):

M. A. Kutin ◽

P. L. Kalinin ◽

A. A. Abdilatipov ◽

A. B. Kurnosov ◽

D. V. Fomichev ◽

...

Keyword(s):

Skull Base ◽

Csf Leak ◽

Main Method ◽

Orbital Roof ◽

Direct View ◽

Anterior Fossa ◽

Cranial Fossa ◽

Skull Base Defect ◽

Keyhole Approach ◽

Skull Base Meningiomas

Transcranial surgery of skull base meningiomas currently remains the main method of treatment. Transnasal removal is possible in a number of cases, but it is associated with the risk of postoperative CSF-leak as a result of insolvency of the reconstruction of the skull base defect. Minimally invasive (keyhole) accesses provide a tumor overview comparable to standard accesses in most cases. The anterior-medial part of the anterior cranial fossa and the olfactory fossa is not accessible to the direct view from the minipterional craniotomy. The use of angular endoscopic optics in combination with additional resection or thinning of the bones in the orbital roof provides an overview sufficient to remove the tumor, but manipulations in this area require the use of specific tools. Aspirators, dissectors and coagulators should have bends of different expressions. The application of the described technique is advisable only in certain specially selected cases.

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