The supraorbital endoscopic approach for tumors.

OBJECTIVE: To describe the indications, technical nuances, and techniques for complication avoidance for the supraorbital keyhole approach with endoscopic assistance. The supraorbital eyebrow craniotomy provides minimally invasive access to a wide range of frontal fossa, parasellar, and some middle and posterior fossae tumors. This approach is considered ideal for removal of many, if not most, planum and tuberculum sellae meningiomas, some olfactory groove meningiomas, and suprasellar craniopharyngiomas, particularly tumors with far lateral extensions. It is also ideal for many intraaxial tumors, including metastases and gliomas arising from the orbitofrontal, frontal pole, and medial temporal lobe regions. The use of endoscopy further extends the range and versatility of this keyhole approach and is considered an essential adjunct for allowing safe and maximal tumor removal.