Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Cranial Base

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons195-ons207 ◽  
Author(s):  
Khaled M. Abdel Aziz ◽  
Sanjay Bhatia ◽  
Mohammed Hammad Tantawy ◽  
Raymond Sekula ◽  
Jeffrey T. Keller ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cosmetic Outcome ◽  
Hospital Length Of Stay ◽  
Anterior Cranial Fossa ◽  
Low Grade ◽  
Closing Time ◽  
Anterior Circulation ◽  
Simpson Grade ◽  
Anterior Cranial Base ◽  
Cranial Fossa

Abstract BACKGROUND Supra orbital frontal minicraniotomy is one of the most commonly used minimally invasive approaches for anterior cranial fossa lesions. OBJECTIVE To describe our experience with the transpalpebral “eyelid” incision to obtain access to the anterior cranial fossa. METHODS We describe the approach and technique of the transpalpebral eyelid incision in a step-by-step fashion and discuss the results of 40 cases for which the eyelid incision was used. We retrospectively reviewed the charts of these patients to analyze outcomes with regard to opening and closing time, length of hospital stay, residual aneurysm or Simpson grade for resection, complications, and cosmetic result. RESULTS We treated 31 anterior circulation aneurysms (28 unruptured and 3 ruptured), 7 anterior skull base meningiomas, 1 frontal low-grade glioma, and 1 frontal cavernoma using the transpalpebral incision. Opening time was about 45 to 60 minutes, and closure time from dura to skin was about 45 to 60 minutes. The hospital length of stay was similar to that in our open craniotomy cases. No residual aneurysm was demonstrated in the follow-up studies of all 31 aneurysms. Simpson grade I resection was achieved in 6 meningiomas. Complications included 1 postoperative eyelid hematoma, 2 postoperative infections, and a subclinical stroke discovered on postoperative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients. CONCLUSION The transpalpebral approach provides dissection in natural anatomical planes, affords preservation of the frontalis muscle, avoids injury to nerve VII branches, and results in an excellent cosmetic outcome.

Eyelid approach to the anterior cranial base

2008 ◽  
Vol 109 (2) ◽  
pp. 341-346 ◽  
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.

Intracranial phosphaturic mesenchymal tumors

2013 ◽  
Vol 118 (4) ◽  
pp. 903-907 ◽  
Author(s):  
Derek A. Mathis ◽  
Edward J. Stehel ◽  
Joseph E. Beshay ◽  
Bruce E. Mickey ◽  
Andrew L. Folpe ◽  
...  
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Immunohistochemical Analysis ◽  
Ethmoid Sinus ◽  
Anterior Cranial Fossa ◽  
Low Grade ◽  
Older Children ◽  
Mesenchymal Tumors ◽  
Cranial Fossa ◽  
The Right ◽  
Fgf 23

Hypophosphatemia with osteomalacia may be due to a neoplasm that produces fibroblast growth factor 23 (FGF-23), which inhibits phosphate reabsorption in the kidneys. Most of these tumors occur in bone or soft tissue and occasionally in the head, although intracranial occurrence is very rare. This report describes a tumor that caused hypophosphatemia and osteomalacia and was located entirely in the right anterior cranial fossa. Radiologically, the tumor resembled a meningioma; histologically, it was a low-grade phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT). After gross-total resection, the patient's symptoms abated and laboratory values normalized. The authors also studied another PMTMCT initially diagnosed as a hemangiopericytoma that involved the left anterior cranial fossa and ethmoid sinus, and reviewed reports of 6 other intracranial tumors that induced osteomalacia, 3 entirely in the anterior cranial fossa, 2 involving the anterior cranial fossa and ethmoid sinus, and 1 in the cavernous sinus. In older children or adults who have hypophosphatemia with osteomalacia and no personal or family history of metabolic, renal, or malabsorptive disease, a neoplasm should be suspected and an imaging workup that includes the brain is warranted, with particular attention to the anterior cranial fossa. Additionally, because there are some overlapping histological features between PMTMCTs and hemangiopericytomas, it may be helpful to assess tumoral FGF-23 expression by reverse transcriptase polymerase chain reaction or immunohistochemical analysis in patients with oncogenic osteomalacia from an intracranial tumor diagnosed as, or resembling, hemangiopericytoma.

scholarly journals Minimally Invasive Supraorbital Key-hole Approach for the Treatment of Anterior Cranial Fossa Meningiomas

2016 ◽  
Vol 56 (4) ◽  
pp. 180-185 ◽  
Author(s):  
Maurizio IACOANGELI ◽  
Niccolò NOCCHI ◽  
Davide NASI ◽  
Alessandro DI RIENZO ◽  
Mauro DOBRAN ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anterior Cranial Fossa ◽  
Cranial Fossa

Craniotomy for anterior cranial fossa meningiomas: historical overview

2014 ◽  
Vol 36 (4) ◽  
pp. E14 ◽  
Author(s):  
Saul F. Morales-Valero ◽  
Jamie J. Van Gompel ◽  
Ioannis Loumiotis ◽  
Giuseppe Lanzino
Keyword(s):  
Cranial Base ◽  
Anterior Cranial Fossa ◽  
Past Century ◽  
Historical Overview ◽  
Surgical Strategies ◽  
The Past ◽  
Harvey Cushing ◽  
Anterior Cranial Base ◽  
Technical Advances ◽  
Cranial Fossa

The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosurgery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical procedures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas.

The versatile frontal sinus approach to the floor of the anterior cranial fossa

1990 ◽  
Vol 72 (3) ◽  
pp. 513-516 ◽  
Author(s):  
John A. Persing ◽  
John A. Jane ◽  
Paul A. Levine ◽  
Robert W. Cantrell
Keyword(s):  
Frontal Sinus ◽  
Cranial Base ◽  
Anterior Cranial Fossa ◽  
Operative Field ◽  
Content Type ◽  
Cosmetic Results ◽  
Anterior Cranial Base ◽  
Cranial Fossa ◽  
Burr Holes ◽  
Fine Print

✓ A technique to expose the anterior cranial base is described with entry through the anterior and posterior walls of the frontal sinus. Burr holes are avoided in the visible portion of the forehead. Expansion of the operative field may be accomplished, if necessary, by supplemental superior frontal or supraorbital rim osteotomy. The technique is rapid, safe, and provides excellent operative exposure and superior cosmetic results.

Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Cranial Fossa: A 104 Cases Experience

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
Khaled Aziz ◽  
M. Darweesh ◽  
G. Al-Shayal ◽  
Kanan Al-Khalely ◽  
P. Maly ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anterior Cranial Fossa ◽  
Cranial Fossa

scholarly journals Anterior Cranial Fossa Calcifying Pseudoneoplasm of the Neuroaxis—Diagnosis Using a Transblepharoplasty Approach

2018 ◽  
Vol 79 (03) ◽  
pp. e75-e78 ◽  
Author(s):  
Timothy Blood ◽  
Fausto Rodriguez ◽  
Norris Nolan ◽  
Murugappan Ramanathan ◽  
Shaun Desai
Keyword(s):  
Frontal Sinus ◽  
Spinal Column ◽  
Pathological Diagnosis ◽  
Anterior Cranial Fossa ◽  
Benign Tumors ◽  
Orbital Roof ◽  
Anterior Cranial Base ◽  
Cranial Fossa ◽  
The Right ◽  
Orbital Rim

AbstractCalcifying pseudoneoplasms of the neuroaxis (CAPNON) are rare, benign tumors of unknown histogenesis. CAPNON generally are found intracranially or within the spinal column in symptomatic patients. We present the case of an asymptomatic patient with an incidentally discovered right anterior cranial fossa mass with extension through the posterior and anterior table of the right frontal sinus and right superior orbital roof. Open biopsy was performed via a transblepharoplasty incision with pathological diagnosis of CAPNON. The biopsy approach was well hidden and resulted in minimal to no postoperative scarring and little postoperative pain. We present the first documented case of CAPNON involving the frontal sinus via the anterior cranial base. Given our experience, in a patient with a mass involving the frontal sinus and superior orbital rim, the transblepharoplasty approach provides excellent exposure and access for pathological diagnosis. Further, we recommend that CAPNON remain on the differential for aggressive appearing calcified masses of the anterior cranial fossa.

TRANSCILIARY ORBITOFRONTOZYGOMATIC APPROACH TO LESIONS OF THE ANTERIOR CRANIAL FOSSA

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons324-ons330 ◽  
Author(s):  
W. Lee Warren ◽  
Gerald A. Grant
Keyword(s):  
Anterior Cranial Fossa ◽  
Surgical Morbidity ◽  
Anterior Circulation ◽  
Invasive Method ◽  
Eyebrow Incision ◽  
Anterior Fossa ◽  
Cranial Fossa ◽  
Keyhole Approach ◽  
Intraoperative Rupture ◽  
Age Range

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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