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The extended eyebrow approach a cadaveric stepwise dissection

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Abstract

Background

The eyebrow incision supraorbital approach is limited by the lack of exposure of the sylvian fissure exposure. By extending the skin incision 15 mm posteriorly and the supraorbital craniotomy beneath the superior temporal line, proximal sylvian dissection is achievable, and the surgical exposure is drastically improved.

Methods

Throughout a cadaveric stepwise dissection and a pertinent anatomical analysis, we describe in detail the surgical technique of the extended eyebrow approach (xEBA). We additionally highlight main anatomical elements involved in this approach and provide technical nuances to avoid complications.

Conclusion

xEBA is a versatile technique that uses the pretemporal, transylvian, and subfrontal corridor to enhance surgical exposure around the anterior cranial fossa.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Rafael Martinez-Perez, Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

  2. Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Douglas A. Hardesty, Ricardo L. Carrau & Daniel M. Prevedello

Authors
  1. Rafael Martinez-Perez
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  2. Douglas A. Hardesty
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  3. Ricardo L. Carrau
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  4. Daniel M. Prevedello
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Corresponding author

Correspondence to Daniel M. Prevedello.

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Patient consent

No lived humans were included in the present study. Informed consent and ethical approval were not deemed necessary by the local ethics in view of the application of strict patient privacy regulations operating in our center (cadavers were unidentified).

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Key points

• As opposed to the frontotemporal incision, the skin incision in the xEBA is not visualized in bald patients or in those with a posteriorly located hairline.

• Eyebrow skin incision and minimal muscle dissection offer excellent cosmetic results and a fast and straightforward route for lesions located in the anterior and middle cranial fossae.

• Interfascial dissection reduces the risk of palsy of the frontotemporal branches of the facial nerve, while it enables the exposure of the orbital rim and facilitates sphenoid ridge drilling.

• Because the inferior limit of the craniotomy is the anterior limit of squamous suture at the pterion, exposure of the sylvian fissure and temporal operculum is ensured.

• There is an increased risk of CSF leakage and infection in cases with excessive frontal sinus pneumatization.

• Sinus cranialization should be performed whenever the frontal sinus is violated.

• Performing a retrograde dissection of the TM without monopolar coagulation prevents atrophy.

• In comparison to the standard eyebrow-supraorbital approach, the allowance for splitting the sylvian fissure reduces frontal lobe retraction.

• The xEBA is a versatile approach that takes advantage of the subfrontal and transylvian corridor to access large anterior cranial fossa lesions.

This article is part of the Topical Collection on Neurosurgical Anatomy

Financial and material support: This study was performed at ALT-VISION at The Ohio State University. Daniel M. Prevedello is a consultant for Integra, Stryker Corporation, and Medtronic Corp. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC and Soliton LLC. Daniel Prevedello receives royalties from KLS-Martin and Mizuho.

Electronic supplementary material

Step-wise cadaveric-surgical simulation of the extended eyebrow approach. 0:09 Skin incision; 0:45 extended eyebrow craniotomy; 1:36 dural opening; 1:50 opening of the prechiasmatic and opticocarotid cisterns; 1:56 sylvian dissection; 2:40 subdural view of posterior circulation (MP4 69226 kb)

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Martinez-Perez, R., Hardesty, D.A., Carrau, R.L. et al. The extended eyebrow approach a cadaveric stepwise dissection. Acta Neurochir 162, 617–621 (2020). https://doi.org/10.1007/s00701-019-04203-w

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  • DOI: https://doi.org/10.1007/s00701-019-04203-w

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