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How I do it: The expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa

  • How I Do it - Neurosurgical Techniques
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Abstract

Background

The supraorbital rim often interferes with the required upward movement of the instruments for resection of large frontal-lobe tumours through a classic supraorbital craniotomy. Here, we present the expanded trans/supraorbital approach to overcome these limitations.

Methods

After an eyebrow skin incision, a one-piece bone flap was created incorporating the orbital rim and roof. Basal extension of the craniotomy allowed for a better intracranial visualisation with improved manoeuvrability and angulation of the instruments without using brain retraction.

Conclusions

This approach poses a feasible alternative to large frontal craniotomies for frontal-lobe tumours, for which a regular supraorbital craniotomy is insufficient.

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References

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Author information

Authors and Affiliations

  1. ENDOMIN—Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden Clinic, Witellikerstr. 40, 8032, Zurich, Switzerland

    Anne-Katrin Hickmann & Robert Reisch

  2. Department of Anaesthesiology and Intensive Care Medicine, Hirslanden Clinic, Zurich, Switzerland

    Britta-Jacqueline Gaida

Authors
  1. Anne-Katrin Hickmann
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  2. Britta-Jacqueline Gaida
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  3. Robert Reisch
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Corresponding author

Correspondence to Anne-Katrin Hickmann.

Ethics declarations

Informed consent for publication of personal images in a scientific journal was obtained from all patients shown in this publication.

Conflicts of interest

Prof. Dr. med. R. Reisch is a consultant to Karl Storz.

Additional information

Key points

1. Removal of the orbital rim facilitates manoeuvrability towards rostro-cranial aspects of the pathology.

2. Even extended lesions within the frontal lobe can be reached without brain retraction.

3. Tumours expanding to the frontal base are optimal as they can be accessed where they reach the surface.

4. To avoid herniation, use of total intravenous anaesthesia and application of mannitol and/or cortisone is recommended.

5. Early CSF release may increase the working space and also prevent herniation.

6. Correct positioning leads to additional gravitational retraction.

7. Approach-related trauma is minimal.

8. No damage to intraorbital structures occurred.

9. Cosmetic results are satisfactory.

10. This approach is a feasible alternative to extended frontal craniotomies.

Electronic supplementary material

Below is the link to the electronic supplementary material.

“How I do it—the trans/supraorbital approach” illustrates the principal steps of this approach for the resection of frontal lobe tumours. The video focuses on the approach itself, as well as closure to achieve optimal cosmetic results, rather than the resection of a frontal lobe pathology. (MP4 339347 kb)

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Hickmann, AK., Gaida, BJ. & Reisch, R. How I do it: The expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa. Acta Neurochir 159, 881–887 (2017). https://doi.org/10.1007/s00701-017-3082-7

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  • DOI: https://doi.org/10.1007/s00701-017-3082-7

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