gms | German Medical Science

Supraorbital approach through an eye-brow skin incision offers wide intracranial exposure treating different lesions of the anterior, middle and even the posterior fossa. The use of this minimally invasive key-hole craniotomy allows maximal therapeutic effect with limited brain exploration and retraction; however, surgical complications and satisfaction of the patients were not yet reported in the literature.

Between January 1993 and December 2002, the supraorbital approach was used in our department in 1013 cases. During this ten years period the senior and first authors have performed 367 supraorbital craniotomies. These cases were retrospectively analyzed reviewing office charts, medical reports, and radiographs. Records were available from 343 patients allowing thorough evaluation of postoperative course and complications. In this group of patients Glasgow Outcome Scale (GOS) was evaluated at the time at discharge and in our outpatient clinic with a median follow-up time of 4 years and 8 months. Recently we were able to re-contact 223 patients with a questionnaire reflecting their satisfaction after supraorbital craniotomy.

The GOS scores for the very heterogeneous group of 343 patients were at discharge 5 in 293 patients (85%), 4 in 27 (7.8%), 3 in 6 (1.7%) and 2 in 9 patients (2.6%). 8 patients died after surgery, 2 in severe re-bleeding, 2 in pulmonary embolism and 4 patients after long intensive care therapy in multi-organ failure, causing a postoperative mortality of 2.3%. During a median follow-up period of 4 years and 8 months GOS has changed as follows: 5 in 277 patients (80%), 4 in 19 (5.5%), 3 in 4 (1.1%) 2 in 14 (4%) and 1 in 29 patients (8.4%). According to the follow-up questionnaire in 223 patients, postoperative scar-pain and headache were determined by the patients in a scale from 1 to 5 (1 = no pain, 5 = severe pain) as follows: 1 in 141 (63%), 2 in 45 (20.2%), 3 in 22 (9.9%), 4 in 12 (5.4%) and 5 in 3 patients (1.3%). Postoperative complaint in chewing was reported from 21 patients [19 temporary (8%), 2 permanent 1%)]; palsy of the frontal muscle from 61 patients [47 temporary (21%), 18 permanent (8%)]; frontal numbness from 94 patients [65 temporary (29%), 29 permanent (13%)]; hyposmia from 51 patients [30 temporary (13%), 21 permanent (9%)]. Postoperative cosmetic outcome was determined from the patients in a scale from 1 to 5 (1 = very pleasant, 5 = no pleasant) as 1 in 157 (70%), 2 in 36 (16.2%), 3 in 22 (9.9%), 4 in 5 (2.2%) and 5 in 3 patients (1.3%).

The supraorbital craniotomy allows limited brain surface exposure compared with minimized brain retraction. The technique with eye-brow skin incision offers acceptable surgical complications and good response among patients.