How I do it: The expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa
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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.
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.
This approach poses a feasible alternative to large frontal craniotomies for frontal-lobe tumours, for which a regular supraorbital craniotomy is insufficient.
KeywordsAnterior fossa Brain tumour Endoscopy Minimally invasive Supraorbital
Compliance with ethical standards
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.
“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)