Background: The eyebrow orbitozygomatic craniotomy is a versatile, minimally invasive approach
utilized to access the anterior skull base, basal frontal and temporal lobes, suprasellar
region, circle of Willis, and ventral midbrain with no fixed brain retraction. Unintentional
breach of the frontal sinus frequently occurs and has been cited as a reason to avoid
this approach. Lack of access to a large pericranial graft and the inability to completely
cranialize the sinus require alternate techniques of repair. We describe a technique
for repairing an opened frontal sinus that includes peeling in local sinus mucosa,
packing betadine soaked Gelfoam into the sinus, covering the opening with dural substitute
and fibrin glue, and medializing the bone flap.
Methods: All patients who underwent an orbitozygomatic craniotomy via an eyebrow incision
by a single surgeon from August 1, 2012, to August 31, 2018, were included in this
retrospective analysis of patients’ medical records. Data were collected on patient
demographics, pathology treated, operative details, and perioperative and 30 day morbidity.
Results: A total of 47 patients with a wide variety of pathologies underwent analysis. The
frontal sinus was breached in 21 patients (42.9%). All patients with an opened frontal
sinus were treated as described above. One patient (ruptured aneurysm) had a suspected
CSF leak postoperatively treated by a single high volume lumbar puncture. No patient
suffered any infection, wound healing problem, complication related to approach or
delayed CSF leak.
Conclusion: Breach of the frontal sinus is common during orbitozygomatic craniotomies via an
eyebrow incision. Despite reduced options for local repair, these patients have experienced
no long-term or delayed CSF problems. Breach of the frontal sinus is not a contraindication
to the eyebrow approach nor should it limit the size of the craniotomy to less than
what is needed for adequate exposure.
