Ahead of Print: Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Cran ial Base

06/10/2011

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BACKGROUND: Supra orbital frontal mini-craniotomy is one of the most commonly used minimally invasive approaches for anterior cranial fossa lesions.

OBJECTIVE: To describe our experience with the transpalpebral “eyelid” incision to obtain access to the anterior cranial fossa.

METHODS: We describe the approach and technique of the transpalpebral “eyelid” incision in a step-by-step fashion, and discuss the results of forty cases for which the “eyelid” incision was utilized. We retrospectively reviewed the charts of these patients to analyze outcomes with regard to opening and closing time, length of hospital stay, residual aneurysm or Simpson Grade for resection, complications, and cosmetic result.

RESULTS: We treated thirty-one anterior circulation aneurysms (twenty-eight unruptured and three ruptured), seven anterior skull base meningiomas, one frontal low-grade glioma, and one frontal cavernoma utilizing the transpalpebral incision. Opening time was about 45 – 60 minutes and closure time from dura to skin was about 45 – 60 minutes. The length of stay in the hospital was similar to our open craniotomy cases. No residual aneurysm was demonstrated in the follow-up studies of all 31 aneurysms. Simpson grade I resection was achieved in six meningiomas. Complications included one post-operative eyelid hematoma, two postoperative infections, and a sub-clinical stroke discovered on post-operative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients.

CONCLUSION: The transpalpebral approach provides dissection in natural anatomical planes, preservation of the frontalis muscle, avoids injury to VII nerve branches, and results in an excellent cosmetic outcome.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.