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.

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.

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.

scholarly journals Minimally Invasive Mini-orbitozygomatic Approach for Clipping an Anterior Communicating Artery Aneurysm: Virtual Reality Surgical Planning

2020 ◽  
Author(s):  
Nicolás González Romo ◽  
Franco Ravera Zunino
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Surgical Planning ◽  
Artery Aneurysm ◽  
Patient Specific ◽  
Anterior Communicating Artery ◽  
Imaging Data ◽  
Advantages And Disadvantages ◽  
Orbitozygomatic Approach ◽  
Skull Base Anatomy

AbstractVirtual reality (VR) has increasingly been implemented in neurosurgical practice. A patient with an unruptured anterior communicating artery (AcoA) aneurysm was referred to our institution. Imaging data from computed tomography angiography (CTA) was used to create a patient specific 3D model of vascular and skull base anatomy, and then processed to a VR compatible environment. Minimally invasive approaches (mini-pterional, supraorbital and mini-orbitozygomatic) were simulated and assessed for adequate vascular exposure in VR. Using an eyebrow approach, a mini-orbitozygomatic approach was performed, with clip exclusion of the aneurysm from the circulation. The step-by-step process of VR planning is outlined, and the advantages and disadvantages for the neurosurgeon of this technology are reviewed.

Incidental Anterior Communicating Artery Aneurysm

2019 ◽  
pp. 25-38
Author(s):  
Kurt Yaeger ◽  
J. Mocco
Keyword(s):  
Collateral Circulation ◽  
Artery Aneurysm ◽  
Careful Analysis ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysm ◽  
Perforating Artery ◽  
Anterior Communicating Artery Aneurysms ◽  
Complex Anatomy ◽  
History Of

Abstract: Anterior communicating artery aneurysms are among the most commonly encountered aneurysms in neurosurgical practice. While many are treatable using modern endovascular techniques, because of their often complex anatomy, both ruptured and unruptured anterior communicating artery aneurysms often require microsurgical treatment. Pre-operative analysis of the collateral circulation, the aneurysm orientation, the aneurysm height, morphology, and the dome-to-neck ratio can all affect decision-making. For unruptured aneurysms, a careful analysis of the natural history of rupture risk versus the risks of surgery or endovascular treatment will determine if treatment is recommended and what modality. At surgery, perforating artery preservation is of utmost importance. This chapter discusses these issues as considered in the management of an incidental, unruptured anterior communicating artery aneurysm.

Classification and Microvascular Flap Selection for Anterior Cranial Fossa Reconstruction

2018 ◽  
Vol 34 (08) ◽  
pp. 590-600 ◽  
Author(s):  
James Vargo ◽  
Wojciech Przylecki ◽  
Paul Camarata ◽  
Brian Andrews
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Cerebrospinal Fluid Leak ◽  
Anterior Cranial Fossa ◽  
Microvascular Reconstruction ◽  
Autologous Reconstruction ◽  
Muscle Flaps ◽  
Defect Groups ◽  
Microvascular Flap ◽  
Cranial Fossa

Background Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. Methods A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue). Subjects were evaluated based on pathologic indication and goal, type of flap used, and complications observed. Results Eleven flaps in 10 subjects were identified and anatomic sites included: low (n = 5), middle (n = 3), and high (n = 3). Eight of 11 reconstructions utilized osteocutaneous flaps including the osteocutaneous radial forearm free flap (OCRFFF) (n = 7) and fibula (n = 1). Other reconstructions included a split calvarial graft wrapped within a temporoparietal fascia free flap (n = 1), latissimus myocutaneous flap (n = 1), and rectus abdominis myofascial flap (n = 1). All 11 flaps were successful without microvascular compromise. No complications were observed in the high and middle ACF defect groups. Two of five flaps in the low defect group using OCRFFF flaps failed to achieve surgical goals despite demonstrating healthy flaps upon re-exploration. Complications included persistent cerebrospinal fluid leak (n = 1) and pneumocephalus (n = 1), requiring flap repositioning in one subject and a second microvascular flap in the second subject to achieve surgical goals. Conclusion In our experience, osteocutaneous flaps (especially the OCRFFF) are preferred for complete autologous reconstruction of high and middle ACF defects. Low skull base defects are more difficult to reconstruct, and consideration of free muscle flaps (no bone) should be weighed as an option in this anatomic area.

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