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

Abstract

Background

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.

Method

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.

Conclusion

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

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References

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    Hickmann AK, Gaida BJ, Reisch R (2017) How I do it: the expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa. Acta Neurochir 159:881–887. https://doi.org/10.1007/s00701-017-3082-7

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    Poblete T, Jiang X, Komune N, Matsushima K, Rhoton AL Jr (2015) Preservation of the nerves to the frontalis muscle during pterional craniotomy. J Neurosurg 122:1274–1282. https://doi.org/10.3171/2014.10.JNS142061

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Author information

Correspondence to A. Venier.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

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

Additional information

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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Keywords

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