Acta Neurochirurgica

, Volume 161, Issue 1, pp 133–137 | Cite as

Transpalpebral approach in skull base surgery: how I do it

  • Revaz Semenovich Dzhindzhikhadze
  • Oleg Nikolaevich Dreval
  • Valeriy Aleksandrovich Lazarev
  • Andrey Victorovich PolyakovEmail author
How I Do it - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm



Keyhole surgery has been actively developing in the last two decades. Modern neuroimaging, preoperative individual planning, and innovative neurosurgical equipment allow us to operate through mini craniotomy with minimization of approach-related complications.


Preoperative planning is very critical. After the patient positioning, skin incision, craniotomy, and dura incision are performed. Intradural lesion is reached with standard microneurosurgical technique. A watertight dura closure is important.


Transpalpebral approach can be good alternative to traditional, extended fronto-lateral craniotomies with excellent cosmetic and functional outcomes. Adequate selection of patients is important.


Keyhole Transpalpebral approach Cerebral aneurysms Skull base surgery Minimally invasive neurosurgery 


Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.

All patient consent

The patients have consented to the submission of this How I Do It for submission to the journal.

Supplementary material

Video 1

File « Transpalpebral approach example (Part 1) »: example of transpalpebral approach from skin incision to craniotomy (MP4 334684 kb)

Video 2

File « Left ICA aneurysm clipping, TPA (Part 2) »: video shows left internal carotid artery aneurysm clipping through transpalpebral approach (MP4 391438 kb)


  1. 1.
    Chiappini A, Marchi F, Reinert M, Robert T (2018) Supraorbital approach through eyebrow skin incision for aneurysm clipping: how I do it. Acta Neurochir (Wien) 160(6):1155–1158CrossRefGoogle Scholar
  2. 2.
    Hickmann AK, Gaida BJ, Reisch R (2017) How I do it: the expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa. Acta Neurochir 159(5):881–887CrossRefGoogle Scholar
  3. 3.
    Kazkayasi M, Batay F, Bademci G, Bengi O, Tekdemir I (2008) The morphometric and cephalometric study of anterior cranial landmarks for surgery. Minim Invasive Neurosurg 51(1):21–25CrossRefGoogle Scholar
  4. 4.
    Mandel M, Tutihashi R, Mandel SA, Teixeira MJ, Figueiredo EG (2017) Minimally invasive transpalpebral “eyelid” approach to unruptured middle cerebral artery aneurysms. OperNeurosurg (Hagerstown) 13(4):453–464Google Scholar
  5. 5.
    Monks D, Weyer A, Thurlow P, Aziz K, Happ E, Goldberg M (2017) Postoperative imaging findings associated with transpalpebral craniotomy approach to anterior cranial Fossa. J Neurol Surg B Skull Base 78(6):481–489CrossRefGoogle Scholar
  6. 6.
    Sanchez-Vazquez MA, Barrera-Calatayud P, Mejia-Villela M, Palma-Silva JF, Juan-Carachure I, Gomez-Aguilar JM, Sanchez-Herrera F (2018) Transciliary subfrontal craniotomy for anterior skull base lesions. Technical note. J Neurosurg 91(5):892–896Google Scholar
  7. 7.
    Xu F, Bambakidis NC (2018) Microsurgical clipping of ruptured anterosuperior-projecting anterior communicating artery aneurysms: how I do it. World Neurosurg S1878-8750(18):31023–31024Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery FGBOU DPO RMANPOThe Ministry of HealthMoscowRussian Federation
  2. 2.City Clinical Hospital Named After F.I. InozemtsevaMoscowRussian Federation
  3. 3.Podolsk CityRussia

Personalised recommendations