Abstract
Background The eyebrow orbitozygomatic craniotomy is a minimally invasive approach that can
access a wide variety of lesions. 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 requires
alternate techniques of sinus repair. We describe a technique for repairing an opened
frontal sinus and retrospectively reviewed complications related to this approach.
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. Data were collected on patient demographics, pathology treated,
operative details, and perioperative morbidity. Follow-up ranged from 6 weeks to 6
years.
Results Total 50 patients with a wide variety of pathologies underwent analysis. Frontal
sinus breach occurred in 21 patients. All were repaired by the described technique.
One patient (ruptured aneurysm) had a suspected cerebrospinal fluid (CSF) leak postoperatively
that resolved without any additional intervention. One patient developed a pneumomeningocele
4 years postoperatively that required reoperation. No patient suffered any infection
or delayed CSF leak.
Conclusion Breach of the frontal sinus is common during eyebrow craniotomies. Despite reduced
options for local repair, these patients have experienced no CSF leaks requiring intervention
and no infections in our series. Long-term mucocele risk is not reliably determined
with our length of follow-up. Breach of the frontal sinus is not a contraindication
to the eyebrow approach.
Keywords
eyebrow craniotomy - orbitozygomatic craniotomy - supraorbital craniotomy - cerebrospinal
fluid leak - frontal sinus - frontal sinus repair - frontal sinus complications -
postoperative infection - mucocele
