J Neurol Surg A Cent Eur Neurosurg 2013; 74(03): 187-191
DOI: 10.1055/s-0032-1333421
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Mini Supraorbital Approach to Inferior Frontal Lobe Cavernous Malformations: Case Series

Michael E. Ivan
1   Department of Neurosurgery, UCSF, San Francisco, California, United States
,
Michael T. Lawton
1   Department of Neurosurgery, UCSF, San Francisco, California, United States
› Author Affiliations
Further Information

Publication History

17 May 2012

11 August 2012

Publication Date:
19 March 2013 (online)

Abstract

Background Anterior surgical approaches to the inferior frontal lobe require large craniotomies with long incisions and some risk of cosmetic defects and surgical morbidity. A mini supraorbital keyhole approach is an alternative to these larger craniotomies. Inferior frontal lobe cavernous malformations are an excellent target for this minimally invasive approach, and we present our experience with two patients.

Methods Two patients with inferior frontal lobe cavernous malformations underwent elective resection of their cavernous malformations through a mini supraorbital craniotomy. The subfrontal exposure opened widely after draining cerebrospinal fluid (CSF) from the carotid cistern to relax the brain. Hemosiderin staining helped identify the underlying cavernous malformations.

Results Both lesions were completely resected. No intraoperative complications, CSF leaks, or neurological deficits were observed.

Conclusion The mini supraorbital keyhole craniotomy with microsurgical technique and neuronavigation is an effective approach for treating cavernous malformations in the inferior frontal lobe. This minimally invasive approach reduces incision size, craniotomy size, and associated complications while enhancing cosmetic outcomes.

 
  • References

  • 1 Park HS, Park SK, Han YM. Microsurgical experience with supraorbital keyhole operations on anterior circulation aneurysms. J Korean Neurosurg Soc 2009; 46: 103-108
  • 2 McArthur LL. Aseptic surgical access to the pituitary body and its neighborhood. J Am Med Assoc 1912; 58: 2009-2011
  • 3 Frazier CH. An approach to the hypophysis through the anterior cranial fossa. Ann Surg 1913; 57: 145-150
  • 4 Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery 1982; 11: 537-542
  • 5 van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 1998; 49: 481-489 , discussion 489–490
  • 6 Fernandes YB, Maitrot D, Kehrli P, Tella Jr OI, Ramina R, Borges G. Supraorbital eyebrow approach to skull base lesions. Arq Neuropsiquiatr 2002; 60: 246-250
  • 7 Yasargil MG, Fox JL. The microsurgical approach to intracranial aneurysms. Surg Neurol 1975; 3: 7-14
  • 8 Zhang MZ, Wang L, Zhang W , et al. The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region. Chin Med J (Engl) 2004; 117: 323-326
  • 9 Wongsirisuwan M, Ananthanandorn A, Prachasinchai P. The comparison of conventional pterional and transciliary keyhole approaches: pro and con. J Med Assoc Thai 2004; 87: 891-897
  • 10 Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 1966; 38: 352-356
  • 11 Seçkin H, Avci E, Uluç K, Niemann D, Başkaya MK. The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus 2008; 25: E4
  • 12 Dare AO, Landi MK, Lopes DK, Grand W. Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. Technical note. J Neurosurg 2001; 95: 714-718