Minimally Invasive Transpalpebral “Eyelid” Craniotomy for Anterior Circulation Aneurysms: Experience with 71 Cases

Introduction: The concept of invasive approaches for the anterior cranial fossa has evolved during the past two decades. Supraorbital frontal minicraniotomy with or without orbitotomy is the commonly utilized approach.

Methods: We describe the transpalpebral eyelid incision which utilizes the natural upper eyelid crease to obtain exposure for anterior circulation aneurysms through the subfrontal–supraorbital corridor. The eyelid approach reduces risk of injury to the frontalis branch of facial nerve. We will review our experience with 71 anterior circulation aneurysms.

Results: Extracranial drilling of the greater sphenoid wing exposes the frontal dura, temporal dura, and periorbita (spheno-orbital keyhole). One piece fronto-orbital craniotomy is performed with an anterior height of approximately 2.5 cm. Optic foraminotomy and anterior clinoidectomy are included when indicated. This provides for a panoramic view of the anterior cranial fossa floor achieved from the ipsilateral to contralateral oculomotor nerve. The results of 71 cases are discussed, including complications of CSF leak, superficial infection, eyelid hematoma, and delayed postoperative cerebellar hematoma.

Conclusion: The transpalpebral approach provides dissection in natural anatomical planes, preserving frontalis muscle, avoiding injury to the facial nerve branches, and results in an excellent cosmetic outcome.

Learning Objective: (1) Understand the extent of exposure gained by this unique approach. (2) Applications and limitations of the approach. (3) Value of cosmetic outcome in modern neurosurgery.

References

References

1 Abdel Aziz KM, Bhatia S, Tantawy MH, et al. Minimally invasive transpalpebral “eyelid” approach to the anterior cranial base. Neurosurgery 2011;69(2, Suppl Operative):ons195–ons206, discussion 206–207

2 Owusu Boahene KD, Lim M, Chu E, Quinones-Hinojosa A. Transpalpebral orbitofrontal craniotomy: a minimally invasive approach to anterior cranial vault lesions. Skull Base 2010;20(4):237–244