gms | German Medical Science

Objective: The main aim in surgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury. The evolution of microsurgical techniques with refined instrumentation and the enormous development of diagnostic tools enable neurosurgeons to treat different lesions through limited and specific keyhole approaches. The concept of keyhole surgery is based on careful study of diagnostic images to determine the anatomic windows that provide access to the lesion. The special architecture of anterior cranial fossa offers several windows to reach deep-seated lesions.

Methods: During a period of 15 years (June 1994 – December 2009) 162 patients with anterior cranial fossa meningiomas were treated using a supraorbital keyhole approach and endoscopic assisted microsurgical technique: The lesions were located at olfactory groove (53), tuberculum sellae – planum sphenoidale (68), anterior clinoid process (41).

Results: Complete removal of tumor was achieved in 147 cases (91%). The most frequent preoperative symptom was visual disturbances. 43 patients (60%) among 71 patients (43,5%) with visual disturbances have experienced marked visual improvement after surgery. 17 patients have had no change in visual function (24%), and 11 patients had worsening of vision postoperatively (16%). The postoperative complications associated with the specific approach were: supraorbital hypesthesia in 8 patients, permanent palsy of the frontal branch of the facial nerve in 7 cases, permanent hyposmia in 9 patients, wound healing disturbances in 4 cases, subcutaneous CSF collection and leak in 4 patients, bleeding in 3 cases.

Conclusions: The supraorbital craniotomy allows a wide exposure of deep-seated intracranial lesions. The supraorbital craniotomy offers equal surgical possibilities with less approach-related morbidity owing to limited exposure of the cerebral surface and minimal brain retraction. Thus contributing to improved postoperative results and shortens hospitalization times. In addition, the short skin incision within the eyebrow and careful soft tissue dissection result in a pleasing cosmetic outcome.