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Berhouma M. Letter to the Editor: Let well alone: can the endoscopic extended endonasal approach to the lateral orbital apex be considered as minimally invasive? J Neurosurg Pediatr 2016; 17:765-6. [PMID: 26919316 DOI: 10.3171/2015.11.peds15682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Superior Eyelid Crease Approach for Transobital Neuroendoscopic Surgery of the Anterior Cranial Fossa. J Craniofac Surg 2013; 24:1616-21. [DOI: 10.1097/scs.0b013e3182a2d635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ E. Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Cranial Base. Oper Neurosurg (Hagerstown) 2011; 69:ons195-206; discussion 206-7. [DOI: 10.1227/neu.0b013e31821c3ea3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Supra orbital frontal minicraniotomy 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 40 cases for which the eyelid incision was used. 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 31 anterior circulation aneurysms (28 unruptured and 3 ruptured), 7 anterior skull base meningiomas, 1 frontal low-grade glioma, and 1 frontal cavernoma using the transpalpebral incision. Opening time was about 45 to 60 minutes, and closure time from dura to skin was about 45 to 60 minutes. The hospital length of stay was similar to that in 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 6 meningiomas. Complications included 1 postoperative eyelid hematoma, 2 postoperative infections, and a subclinical stroke discovered on postoperative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients.
CONCLUSION
The transpalpebral approach provides dissection in natural anatomical planes, affords preservation of the frontalis muscle, avoids injury to nerve VII branches, and results in an excellent cosmetic outcome.
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Affiliation(s)
| | | | | | | | - Jeffrey T. Keller
- Departments of Ophthalmology, Allegheny General Hospital, Drexel College of Medicine, Pittsburgh, Pennsylvania
| | - Sebastien Froelich
- Departments of Neurosurgery, University of Cincinnati College of Medicine and the Mayfield Clinic, Cincinnati, Ohio
| | - Erik Happ
- Departments of Neurosurgery, University of Strasbourg, Strasbourg, France
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Dutton JJ. Orbital Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Andaluz N, Romano A, Reddy LV, Zuccarello M. Eyelid approach to the anterior cranial base. J Neurosurg 2008; 109:341-6. [DOI: 10.3171/jns/2008/109/8/0341] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Skull base approaches play a fundamental role in modern neurosurgery by reducing surgical morbidity. Increasing experience has allowed surgeons to perform minimally invasive approaches without straying from the premises of skull base surgery. The eyelid approach has evolved from the orbitopterional osteotomy into a more effective and targeted approach to disease of the anterior cranial fossa. In this technique, after an incision is made on the supratarsal fold, the orbicularis oculi muscle is incised, and a myocutaneous flap composed of the elements of the anterior lamella is elevated. Subperiosteal dissection is used to expose the superior and lateral walls of the orbit, the superior and lateral orbital rim, and the frontosphenoidal suture. A MacCarty bur hole is drilled, and a frontal osteotomy is fashioned medial to the supraorbital notch and extending through the orbital roof back toward the orbital half of the MacCarty bur hole, exposing the frontobasal brain. A conventional microsurgical technique is used to treat tumors and aneurysms of the anterior cranial fossa under the operative microscope.
Five patients were treated for unruptured aneurysms of the anterior circulation (3 anterior communicating artery aneurysms, 1 ophthalmic artery aneurysm, and 1 posterior communicating artery aneurysm) using the eyelid approach. The mean aneurysm size was 5 mm, and all aneurysms were approached from the right side. Three tumors in the anterior fossa (2 suprasellar pituitary adenomas and 1 craniopharyngioma) were also excised using this approach. There was no surgical morbidity. Three months after surgery all patients presented excellent cosmetic results. The eyelid approach may be considered as an effective, cosmetically beneficial, and minimally invasive skull base approach to selected aneurysms and tumors of the anterior circulation.
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Affiliation(s)
- Norberto Andaluz
- 1Department of Neurosurgery, University of South Florida, Tampa, Florida
| | - Alberto Romano
- 2Neurosurgical Unit, Instituto Ortopedico Villa Salus, Augusta, Italy
| | - Likith V. Reddy
- 3Division of Oral and Maxillofacial Surgery, Department of Surgery; and
| | - Mario Zuccarello
- 4Department of Neurosurgery and
- 5The Neuroscience Institute, Mayfield Clinic, University of Cincinnati College of Medicine, Cincinnati, Ohio
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