Supraorbital keyhole approach for suprasellar arachnoid cyst: how I do it



Keyhole approaches have lately sparked strong interest because these approaches address skull base pathologies as reported by Eroglu et al. (World Neurosurg, 2019); Hickmann, Gaida, and Reisch (Acta Neurochir (Wien) 159:881–887, 2017); Jallo and Bognar (Neurosurgery, 2006); and Poblete et al. (J Neurosurg 122:1274–1282, 2015), minimizing brain retraction and improving cosmetic results. We describe the step-by-step surgical technique to drain a suprasellar arachnoid cyst by a supraorbital approach.


The eyebrow incision is a direct route to expose the supraorbital corridor and even if it is smaller than a pterional approach, it permits to open the cisterns and to visualize neurovascular structures. The arachnoid cyst could be safely drained and a T-tube is placed.


This technique represents a suitable option for suprasellar arachnoid cyst, avoiding more extended and invasive approaches.

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Correspondence to A. Venier.

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The authors declare that they have no conflicts of interest.

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Informed consent was obtained from the individual participant included in the study.

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Key Points

1. Anatomical knowledge of superficial neurovascular structures is essential;

2. Only for expert surgeon with an appropriate learning curve to become familiar with narrow corridors and limited workspace;

3. Head extension is important to allow gravity retraction of the frontal lobes;

4. The keyhole location is crucial and should be placed only after fronto-zygomatic suture visualization;

5. The position and the oblique orientation of the craniotomy along the orbital roof have to be the most caudally possible;

6. The drilling of the orbital roof and the lesser sphenoid wing helps to open the supraorbital corridor;

7. Early extended opening of arachnoid cisterns to gain extra space is necessary;

8. Identification of optic nerves, chiasm, and internal carotid artery is critical;

9. Preoperative evaluation of frontal sinus and eyebrow is mandatory;

10. Shorter hospital stays and optimal cosmetic results.

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This article is part of the Topical Collection on Pituitaries

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Suprasellar arachnoid cyst opening by supraorbital keyhole approach through eyebrow skin incision. (MP4 252139 kb)

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Suprasellar arachnoid cyst opening by supraorbital keyhole approach through eyebrow skin incision. (MP4 252139 kb)

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Venier, A., Reinert, M. & Robert, T. Supraorbital keyhole approach for suprasellar arachnoid cyst: how I do it. Acta Neurochir 161, 1709–1713 (2019) doi:10.1007/s00701-019-03965-7

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  • Supraorbital approach
  • Eyebrow incision
  • Minimally invasive technique
  • Suprasellar cyst