Marcos Devanir Silva da Costa1, Douglas A Hardesty2, Blake Priddy3, Raywat Noiphithak4, Juan Manuel Revuelta Barbero5, Daniel M Prevedello6. 1. Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil. Electronic address: marcoscostaneuro@gmail.com. 2. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. 3. Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA. 4. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. 5. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain. 6. Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
Abstract
BACKGROUND: The extended supraorbital approach through a modified eyebrow incision is a minimally invasive variant of the frontotemporal or pterional approach that enriches a neurosurgeon's armamentarium for the treatment of pathologies lateral to the anterior clinoid process, by advancing laterally with frontal facial nerve branches monitoring. To demonstrate the steps of the approach, we studied 2 formalin-fixed and artery/vein silicone-injected adult cadaveric heads, and reviewed 1 of the 3 clinical cases operated on to illustrate the applicability of the approach. CLINICAL PRESENTATION: A 56-year-old woman presented with a history of seizures and a complaint of headache that started 2 months ago. She underwent an examination with brain magnetic resonance imaging that showed a dural-based lesion at the medial third of the lesser wing of sphenoid (which is consistent with meningioma). The patient underwent craniotomy with an extended supraorbital approach through a modified eyebrow incision that allowed Simpson grade II removal to be performed and good aesthetic outcome to be achieved. CONCLUSIONS: The extended supraorbital approach through a modified eyebrow incision is a minimally invasive approach that can add to a neurosurgeon's armamentarium and be used with microscopy, assisted by endoscope, or both to reach the anterior and middle cranial fossae.
BACKGROUND: The extended supraorbital approach through a modified eyebrow incision is a minimally invasive variant of the frontotemporal or pterional approach that enriches a neurosurgeon's armamentarium for the treatment of pathologies lateral to the anterior clinoid process, by advancing laterally with frontal facial nerve branches monitoring. To demonstrate the steps of the approach, we studied 2 formalin-fixed and artery/vein silicone-injected adult cadaveric heads, and reviewed 1 of the 3 clinical cases operated on to illustrate the applicability of the approach. CLINICAL PRESENTATION: A 56-year-old woman presented with a history of seizures and a complaint of headache that started 2 months ago. She underwent an examination with brain magnetic resonance imaging that showed a dural-based lesion at the medial third of the lesser wing of sphenoid (which is consistent with meningioma). The patient underwent craniotomy with an extended supraorbital approach through a modified eyebrow incision that allowed Simpson grade II removal to be performed and good aesthetic outcome to be achieved. CONCLUSIONS: The extended supraorbital approach through a modified eyebrow incision is a minimally invasive approach that can add to a neurosurgeon's armamentarium and be used with microscopy, assisted by endoscope, or both to reach the anterior and middle cranial fossae.
Authors: J Manuel Revuelta Barbero; Rima S Rindler; Clara Martin; Marcelo Orellana; Edoardo Porto; C Arturo Solares; Gustavo Pradilla Journal: Surg Neurol Int Date: 2022-03-18