Artikel
Advantages and limits of the supraorbital keyhole approach for supra-, para- and retrosellar lesions
Möglichkeiten und Grenzen der supraorbitalen Minikraniotomie bei supra-, para- und retrosellären Prozessen
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Supra-, para- und retrosellar lesions require distinguished planning of localization and size of the craniotomy as well as necessity of additional technical tools such as neuronavigation, intraoperative imaging or endoscopy. This study demonstrates advantages and limits of the fronto-latero-basal approach in terms of a keyhole craniotomy via an eye brow incision for such lesions.
Methods
Between 2/2003 and 12/2004 we performed supraorbital keyhole approaches in 51 patients with supra-, para- or retrosellar lesions. Lesions consisted of vascular malformations in 34 patients (30 aneurysms, 2 AVM´s, 2 cavernomas) and tumours in 17 patients (6 meningeomas, 5 gliomas, 2 craniopharyngeomas, 2 epidermoids, 2 pituitary adenomas). In 11 patients, neuronavigation, and in 14 patients, endoscopy was used. The supraorbital craniotomy was performed in prone position through a 4 cm skin incision in the eye brow with an average diameter of 2x3 cm.
Results
All lesions could be sufficiently approached using the described supraorbital keyhole craniotomy. Limits were extension of the lesion into the temporo-polar region or the third ventricle. 2 patients with CSF fistulas due to opening of the frontal sinus required a second surgical treatment.
Conclusions
The supraorbital keyhole craniotomy was found to be sufficient for a variety of supra-, para- and retrosellar lesions. Limits were extension of the lesion into the temporo-polar region or the third ventricle. Additional technical tools such as neuronavigation, intraoperative ultrasound and endoscopy were found to be helpful in tumours in order to achieve optimal control and complete resection of the lesion.