Supraorbital Approach

Abstract

Meningiomas of the anterior cranial fossa can be challenging lesions. They may spread extensively along the frontal skullbase and often involve olfactory tracts, optic nerves, pituitary stalk, carotid artery, and the anterior cerebral artery complex [1, 2]. Tumor resection via transcranial microsurgical approaches has been the standard of care for most of these lesions since more than 30 years. The surgical results have been improved significantly over the years because of refinement of the microsurgical instrumentation and dissection technique, better understanding of the surgical anatomy, and the availability of high-resolution MR imaging. After a period of extensive skullbase approaches which were mainly proposed in the late 1980s and 1990s [3–5], in the last decade, standard craniotomies have been recommended for skullbase tumors to reduce the approach-related morbidity and to improve the quality of life after surgery [1, 2]. A further step to reduce the approach-related trauma is the development of small craniotomies, also called mini-craniotomies or keyhole approaches [6]. For frontal skullbase meningiomas, the supraorbital craniotomy performed via an eyebrow incision is the most frequently used minimally invasive approach to that region. It is simply a smaller version of the standard frontolateral approach. Axel Perneczky was the main promoter of the eyebrow approach and used it for several lesions of the frontal skullbase [7–10]. Although the supraorbital approach provides a good overview over the anterior cranial base, there are some blind corners. Therefore, the additional use of endoscopes with various angles of view is sometimes advantageous to improve the visualization without the need for retraction [11]. The supraorbital craniotomy is a minimally invasive alternative to the endonasal approach, which has become popular recently in the treatment of anterior skullbase meningiomas [12–14].