Acta Neurochirurgica

, Volume 159, Issue 5, pp 881–887

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

  • Anne-Katrin Hickmann
  • Britta-Jacqueline Gaida
  • Robert Reisch
How I Do it - Neurosurgical Techniques

DOI: 10.1007/s00701-017-3082-7

Cite this article as:
Hickmann, AK., Gaida, BJ. & Reisch, R. Acta Neurochir (2017) 159: 881. doi:10.1007/s00701-017-3082-7



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.


Anterior fossa Brain tumour Endoscopy Minimally invasive Supraorbital 

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)

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Anne-Katrin Hickmann
    • 1
  • Britta-Jacqueline Gaida
    • 2
  • Robert Reisch
    • 1
  1. 1.ENDOMIN—Center for Endoscopic and Minimally Invasive NeurosurgeryHirslanden ClinicZurichSwitzerland
  2. 2.Department of Anaesthesiology and Intensive Care MedicineHirslanden ClinicZurichSwitzerland

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