Supraorbital approach for repair of open anterior skull base fracture

2008 ◽  
Vol 2 (6) ◽  
pp. 420-423 ◽  
Author(s):  
Katalin A. Szabo ◽  
Samuel H. Cheshier ◽  
M. Yashar S. Kalani ◽  
Jonathan W. Kim ◽  
Raphael Guzman
Keyword(s):  
Skull Base ◽  
Recovery Time ◽  
Anterior Skull Base ◽  
Dural Tear ◽  
Penetrating Injuries ◽  
Skull Base Fracture ◽  
Orbital Roof ◽  
Supraorbital Approach ◽  
Left Eyelid ◽  
Orbital Roof Fractures

To the authors' knowledge, this is the first report of the use of anterior orbitotomy via the supraorbital eyelid crease to repair a dural tear caused by an orbital roof fracture. When transorbital penetrating injuries occur in children, they are commonly caused by accidental falls onto pointed objects. The authors report on their experience with a 7-year-old girl who fell onto a blunt metal rod hanger that penetrated her left eyelid, traversed superior to the eye globe, and penetrated the orbital roof at a depth of 3–4 cm, lacerating the dura mater and entering the cerebrum. An anterior transpalpebral transorbital approach was used to perform the microsurgical anterior skull base and dural repair. The authors advocate the application of this approach to orbital roof fractures because it provides excellent access to the orbital roof, eliminates the need for more invasive craniotomy, results in a small and well-hidden scar in the eye crease, and overall offers a shorter recovery time with less psychological stress to the patient.

Residual and Recurrent Disease Following Endoscopic Endonasal Approach as a Reflection of Anatomic Limitation for the Resection of Midline Anterior Skull Base Meningiomas

2021 ◽  
Author(s):  
Pradeep Setty ◽  
Juan C Fernandez-Miranda ◽  
Eric W Wang ◽  
Carl H Snyderman ◽  
Paul A Gardner
Keyword(s):  
Optic Nerve ◽  
Skull Base ◽  
Retrospective Chart Review ◽  
Residual Tumor ◽  
Average Diameter ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Orbital Roof ◽  
Skull Base Meningiomas

Abstract BACKGROUND Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear. OBJECTIVE To show the anatomic limits of EEA for meningiomas. METHODS Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014. RESULTS A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx. CONCLUSION Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.

Supraorbital Keyhole Craniotomy for Basilar Artery Aneurysms: Accounting for the “Cliff” Effect

2017 ◽  
Vol 13 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Melissa M. Stamates ◽  
Andrew K. Wong ◽  
Anita Bhansali ◽  
Ricky H. Wong
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Pairwise Comparison ◽  
Anterior Skull Base ◽  
Base Line ◽  
Vascular Control ◽  
Surgical Clipping ◽  
Orbital Roof ◽  
True Value ◽  
Cliff Effect

Abstract BACKGROUND: Treatment of basilar artery aneurysms is challenging. While endovascular techniques have dominated, there still remain circumstances where open surgical clipping is required or preferred. Minimally invasive “keyhole” approaches are being used more frequently to provide the durability of surgical clipping with a lower morbidity profile; however, careful patient selection is required. The supraorbital “keyhole” approach has been described for the treatment of basilar artery aneurysms, but careful assessment of the basilar exposure is necessary to ensure proper visualization of the aneurysm and ability to obtain proximal vascular control. Various methods of estimating the basilar artery exposure in this approach have been described, including the anterior skull base line and the posterior clinoid line, but both are unreliable and inaccurate. OBJECTIVE: To propose a new method, the orbital roof-dorsum line, to simply and accurately predict the basilar artery exposure. METHODS: CT angiograms for 20 consecutive unique patients were analyzed to obtain the anterior skull base line, posterior clinoid line, and the orbital roof-dorsum line. CT angiograms were then loaded onto a Stealth neuronavigation system (Medtronic, Minneapolis, Minnesota) to obtain “true” visualization lengths. A case illustration is presented. RESULTS: Pairwise comparison tests demonstrated that both the anterior skull base and the posterior clinoid estimation lines differed significantly from the “true”  value (P < .0001). Our orbital roof-dorsum estimation provided results that accurately predicted the “true” value (P = .71). CONCLUSION: The orbital roof-dorsum line provides a simple and reliable method of estimating basilar artery exposure and should be used whenever considering patients for surgical clipping by this approach.

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

2016 ◽  
Vol 124 (3) ◽  
pp. 647-656 ◽  
Author(s):  
Jacob B. Archer ◽  
Hai Sun ◽  
Phillip A. Bonney ◽  
Yan Daniel Zhao ◽  
Jared C. Hiebert ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Class Ii ◽  
Anterior Skull Base ◽  
Csf Leak ◽  
Class Iii ◽  
Skull Base Fracture ◽  
Tissue Flaps ◽  
Repair Techniques

OBJECT This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. METHODS Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. RESULTS Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients’ mean age was 33 years (range 11–79 years). The mean overall length of follow-up was 14 months (range 5–45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)—1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. CONCLUSIONS Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

scholarly journals Impact of anterior skull base fracture on lateralized olfactory function

2019 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
V. Gudziol ◽  
T. Marschke ◽  
J. Reden ◽  
T. Hummel
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Olfactory Function ◽  
Skull Base Fracture
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