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The supraorbital keyhole approach: how I do it

Abstract

Background

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

Methods

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.

Conclusions

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

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Abbreviations

CN I:

Olfactory nerve

CN II:

Optic nerve

CG:

Crista galli

ICA:

Internal carotid artery

iCT:

Intraoperative computed tomography

FB:

Frontal skull base

MRI:

Magnetic resonance imaging

OG:

Olfactory groove

References

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    Zador Z, Gnanalingham K (2013) Eyebrow craniotomy for anterior skull base lesions: how I do it. Acta Neurochir 155:99–106

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    Reisch R, Marcus HJ, Hugelshofer M, Koechlin NO, Stadie A, Kockro RA (2014) Patients’ cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision. J Neurosurg 121:730–734

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Acknowledgments

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.

Conflicts of interest

None.

Author information

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). https://doi.org/10.1007/s00701-015-2424-6

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Keywords

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