Abstract
Background Supraorbital eyebrow craniotomy is a minimally invasive alternative to a frontotemporal
craniotomy and is often used for tumor and vascular pathologies. The purpose of this
study was to investigate how patient cosmetic outcomes are affected by technique variations
of this approach.
Methods PubMed, Embase, and Scopus databases were systematically searched, and results were
reported according to PRISMA guidelines. For the meta-analysis portion, the DerSimonian–Laird
random effects model was used, and the primary end points were patient satisfaction
and percentage of permanent cosmetic complications.
Results A total of 2,629 manuscripts were identified. Of those, 124 studies (8,241 surgical
cases) met the inclusion criteria. Overall, 93.04 ± 11.93% of patients reported favorable
cosmetic outcome following supraorbital craniotomy, and mean number of cases with
permanent cosmetic complications was 6.62 ± 12.53%. We found that vascular cases are
associated with more favorable cosmetic outcomes than tumor cases (p = 0.0001). Addition of orbital osteotomy or use of a drain is associated with adverse
cosmetic outcomes (p = 0.001 and p = 0.0001, respectively). The location of incision, size of craniotomy, utilization
of an endoscope, method of cranial reconstruction, skin closure, use of antibiotics,
and addition of pressure dressing did not significantly impact cosmetic outcomes (p > 0.05 for all).
Conclusions Supraorbital craniotomy is a minimally invasive technique associated with generally
high favorable cosmetic outcomes. While certain techniques used in supraorbital keyhole
approach do not pose significant cosmetic risks, utilization of an orbital osteotomy
and the addition of a drain correlate with unfavorable cosmetic outcomes.
Keywords
cosmesis - eyebrow - keyhole - orbital osteotomy - supraorbital - technique
