The supraorbital keyhole approach: how I do it



Improvements in image guidance, endoscopy, and instruments, have significantly advanced “keyhole” neurosurgery. We describe the concept and technique of the supraorbital keyhole approach.


The supraorbital keyhole approach is performed through an eyebrow skin incision. Image guidance may be used to define the optimal surgical trajectory. A limited supraorbital craniotomy is fashioned. The frontal lobe is mobilized and the central skull base approached, without the need for brain retractors. Endoscopy is used to enhance visualization, and tube-shaft instruments to improve manipulation through the narrow surgical corridor.


The supraorbital keyhole approach provides a safe method to access selected skull base lesions.

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Fig. 1
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Olfactory nerve


Optic nerve


Crista galli


Internal carotid artery


Intraoperative computed tomography


Frontal skull base


Magnetic resonance imaging


Olfactory groove


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We express our gratitude to Zsolt Kulcsár, Daniel Rüfenacht, Isabel Wanke, and Stefan Wetzel for neuroradiological and interventional support and excellent daily cooperation. Hans Rudolf Briner performed the pre- and postoperative olfaction tests, Dominik Zumsteg the intraoperative neuromonitoring, and Karen Wachter the pre- and postoperative neuropsychological evaluations in the presented illustrative case.

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Correspondence to Robert Reisch.

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Reisch, R., Marcus, H.J., Kockro, R.A. et al. The supraorbital keyhole approach: how I do it. Acta Neurochir 157, 979–983 (2015).

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  • Minimally invasive neurosurgery
  • Neuroendoscopy
  • Skull base surgery
  • Supraorbital keyhole