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The supraorbital approach—a minimally invasive approach to the superior orbit

  • Neurosurgical Techniques
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Abstract

Background

We present a minimally invasive approach to the superior orbit via an eyebrow incision with a small osteotomy, minimal orbital rim resection and small frontal craniotomy.

Methods

This approach was used in 20 patients with a well-defined intra-and extraconal lesion superior to the optic nerve, who underwent surgery between 2000 and 2007.

Results

This approach is purely extradural with minimal brain and orbital retraction. The size of the lesion was not a limiting factor. Sensory deficits in the territory of the supraorbital nerve resolved within 7 months on average.

Conclusion

This approach presents a combination of an extra-and transcranial approach, which is indicated in all orbital lesions superior to the optic nerve. The clinical and cosmetic results are excellent.

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Acknowledgement

We thank Prof. Seeger for the drawings.

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Authors and Affiliations

  1. Neurosurgery, Wedau Kliniken, Duisburg, Germany

    Werner Hassler & Uta Schick

  2. Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Uta Schick

Authors
  1. Werner Hassler
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  2. Uta Schick
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Corresponding author

Correspondence to Uta Schick.

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Comments

This report describes a new modification of a combined extra- and intracranial purely extradural approach to the superior orbit via an eyebrow incision. This approach was used in 20 patients, also for larger lesions, all located above the optic nerve. The only relevant morbidity encountered was one fistula to the frontal sinus and temporary hypesthesia in the area of the supraorbital nerve in all patients, which resolved within a mean of 7 months after surgery. Cosmetic results are described to be excellent. The major advantage of this approach is the good overview of the superior orbit in spite of a small incision and a limited approach.

Lesions within the orbit are rare, and this report offers an adequate introduction into a modified technique. The authors are known for their longstanding experience in dealing with orbital pathology. The number of 20 patients operated with this approach is large enough to draw the conclusion, that this approach is a valuable alternative to other approaches to the superior orbit. However, future experience in larger patient groups - although these are difficult to collect due to the low incidence of such findings - has to be obtained to finally confirm the potential benefits. Surgery of orbital lesions will probably remain mostly dependent on individual surgical experience, controlled studies seem to be not realistic in this field, so far.

Hans Clusmann

Bonn, Germany

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Hassler, W., Schick, U. The supraorbital approach—a minimally invasive approach to the superior orbit. Acta Neurochir 151, 605–612 (2009). https://doi.org/10.1007/s00701-009-0301-x

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  • DOI: https://doi.org/10.1007/s00701-009-0301-x

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