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Same viewing angle, minimal craniotomy enlargement, extreme exposure increase: the extended supraorbital eyebrow approach

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Abstract

The supraorbital eyebrow approach (SEa) has been commonly used as a straightforward route to reach lesions located in the anterior cranial fossa. The reduced surgical exposure provided by this approach limits its applicability. A modification of the SEa, the extended supraorbital eyebrow approach (X-SEa), allows use of the transylvian corridor to approach parasellar lesions, while maintaining most of the aesthetic advantages of the SEa. To quantify the surgical exposure and maneuverability provided by the X-SEa using a cadaveric study. Eleven heads were used to obtain all stereotactic measurements. Surgical exposure and maneuverability were measured by means of the area of exposure and the angles of attack along key representative points in the anterior circulation. The horizontal angle of attack at the middle cerebral artery provided by the X-SEa was larger than that provided by the SEa (32.6 vs 18.4°, p = 0.009). The X-SEa afforded broader vertical angles of attack at all targets in the anterior circulation (p < 0.05). The total area of exposure provided by the X-SEa was significantly larger than that provided by the SEa (1272 vs 978 ± 156 mm2, p = 0.003). The area of exposure in the ipsilateral trigon and in the midline quadrangle was also significantly larger for the X-SEa (paramedian 195 vs 121 mm2, p = 0.01; midline 1310 vs 778 mm2, p = 0.002). The X-SEa increases the exposure and surgical maneuverability along the anterior and middle cranial fossa when compared to the standard SEa.

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Abbreviations

AComA:

anterior communicating artery

AoA:

angle of attack

H-AoA:

horizontal angle of attack

MCA:

middle cerebral artery

MIA:

minimally invasive approach

PCA:

posterior cerebral artery

SEa:

supraorbital eyebrow approach

V-AoA:

vertical angle of attack

X-SEa:

extreme supraorbital eyebrow approach

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Acknowledgments

Anatomical dissections and measurements were performed at the ALT-VISION dissection lab at The Ohio State University.

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Authors and Affiliations

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

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

  2. Department of Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

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

Authors
  1. Rafael Martinez-Perez
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  2. Thiago Albonette-Felicio
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  3. Douglas A. Hardesty
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  4. Ricardo L. Carrau
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  5. Daniel M. Prevedello
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Corresponding authors

Correspondence to Rafael Martinez-Perez or Daniel M. Prevedello.

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Conflict of interest

Daniel M. Prevedello is a consultant for Integra LifeSciences Corp, Stryker Corporation, and Medtronic Corp. He has equity on 3 rivers LLC, eLUM Technologies, LLC and Soliton LLC. He receives royalties from KLS-Martin and Mizuho.

Ethical approval and informed consent

Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study (retrospective) and the application of strict patient privacy regulations operating in our center (cadavers were unidentified).

Additional information

This manuscript has not been previously published in whole or in part or submitted elsewhere for review.

This study is important as it provides a new variation of a minimally invasive approach that expands previous indications for supraoprbital eyebrow approach, while it maintains most of its advantages. An increase on the area of exposure, by adding a minimal bone removal, exponentially improves the surgical view in the deepening of the sylvan fissure and the surgical manipulability.

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Martinez-Perez, R., Albonette-Felicio, T., Hardesty, D.A. et al. Same viewing angle, minimal craniotomy enlargement, extreme exposure increase: the extended supraorbital eyebrow approach. Neurosurg Rev 44, 1141–1150 (2021). https://doi.org/10.1007/s10143-020-01306-2

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  • DOI: https://doi.org/10.1007/s10143-020-01306-2

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