Surgical management of anterior skull base compartment tumors through an eyebrow incision and supraorbital keyhole craniotomy

Introduction: Surgical treatment for anteriorly located frontal or skull base tumors is routinely done by pterional, cranio-orbitozygomatic or bifrontal approaches with frequent shrinkage of the frontal cortex.

Objective: We aimed to demonstrate that access through supraorbital keyholes approach is feasible for anterior skull base tumors, allowing satisfactory resection with less brain retraction and proper aesthetic results.

Methods: We reviewed prospectively ten patients operated from January 2015 to December 2016, with 6 months follow-up, by two neurosurgeons. In all cases we made a supraorbital keyhole craniotomy without removal of the orbital rim, with eyebrow incision.

Results: We operated seven females and three male patients. The average age was 44,9 years. We had 6 cases of tuberculum sellae meningiomas, one of them with a concomitant frontal inferior convexity meningioma, one frontal orbital gyrus cavernoma, one Craniopharyngioma, one giant Pituitary Adenoma and a sphenoid greater wing meningioma. We have reached gross total resection in all cases. We did not observe complications related to neurovascular structures handling neither cranial closure (none CSF leak) with good aesthetic result in all cases. We obtained 10% of frontal hyperesthesia and 20% transitory hormonal deficit.

Discussion: Routinely large craniotomies are chosen for anterior skull base tumors, with subfrontal cortex handling, requiring in some cases section of the anterior sagittal sinus and sometimes frontal sinus massive exposure. Concern about these morbidities we saw a growing need for development of surgical techniques that allow adequate access to anterior skull base with less tissue manipulation. As we can see in our results the use of minimally invasive approach through supraorbital keyhole craniotomies allows satisfactory resection without increase morbidity.

Conclusion: Supraorbital keyhole craniotomy allow satisfactory access to the anterior skull base compartment associated with good oncologic and aesthetic results.