Artikel
The supraorbital craniotomy for surgical treatment of supra-and parasellar meningeomas
Der supraorbitale Zugang zur Resektion von supra- und parasellären Meningeomen
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Autoren
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R. Reisch
- Klinik für Neurochirurgie, Universitätsklinikum Mainz
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A. Perneczky
- Klinik für Neurochirurgie, Universitätsklinikum Mainz
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
The supraorbital craniotomy allows wide intracranial exposure of the deep-seated supra- and parasellar region, according to the concept of keyhole approaches.
Methods
Between Juli 1995 and June 2004, the supraorbital approach was used in our department in 1216 cases. After eyebrow skin incision and careful soft tissue dissection a limited supraorbital craniotomy was carried out with a diameter of ca. 10x15 mm. As a real frontolateral approach, the supraorbital craniotomy avoided removal of the orbital rim, lesser sphenoid wing or the zygomatic arch. During this ten years period, the authors performed 513 supraorbital craniotomies. These cases were retrospectively analyzed reviewing patient charts, medical reports, and radiographs. Records were available from 497 patients, from these patients 144 were treated with supra- and parasellar meningeomas. The tumour matrix was localized in 71 cases (49%) at the anterior clinoid process, in 59 cases (41%) at the planum sphenoidale and in 14 cases (10%) at the dorsum sellae. Preoperatively, the tumour caused visual field defects in 86 cases (60%), eye-movement disturbances in 23 cases (16%), pituitary malfunction in 6 cases (4%).
Results
In every case, the limited supraorbital craniotomy allowed sufficient surgical approach to the suprasellar region, an enlargement of the craniotomy was not necessary. Three months postoperatively, MRI showed in 132 cases (92%) complete, in 9 cases (6%) subtotal and in 3 cases (2%) partial tumour removal. Three months after surgery, visual improvement was recorded in 67 of 86 cases (78%), visual impairment in 11 of 144 cases (8%). The preoperative diplopia showed regeneration in 14 of 23 cases (61%), impairment was recorded in 6 of 144 cases (4%). Patients with pituitary disturbances did not show postoperative hormonal recovery, additional hormonal disturbances were recorded in 3 of 144 cases (2%).
Conclusions
The minimally invasive, limited supraorbital craniotomy offers adequate surgical exposure and acceptable postoperative results with minimal brain retraction without approach-related complications. In addition, the short skin incision within the eyebrow, careful soft tissue dissection and limited craniotomy result in a pleasing cosmetic outcome after surgery.
