Skip to main content

10 Keyhole Supraorbital Craniotomy: Eyelid and Eyebrow Approaches

  • Chapter
  • First Online:
Endoscopic and Keyhole Cranial Base Surgery

Abstract

The keyhole supraorbital craniotomy provides a versatile approach to many vascular lesions and tumors of the anterior and middle fossa. Eyelid and eyebrow approaches allow the keyhole craniotomy to also minimize soft tissue trauma to the scalp and face. These techniques reduce initial exposure time, blood loss, and postsurgical pain and discomfort with very low infection rates compared to the traditional pterional approach. Both the eyelid and eyebrow incision have excellent long-term cosmetic outcomes and patient satisfaction rates.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol. 1998;49(5):481–90.

    Article  PubMed  Google Scholar 

  2. Chen HC, Tzaan WC. Microsurgical supraorbital keyhole approach to the anterior cranial base. J Clin Neurosci. 2010;17(12):1510–4.

    Article  PubMed  Google Scholar 

  3. Welling LC, Figueiredo EG, Wen HT, Gomes MQ, Bor-Seng-Shu E, Casarolli C, Guirado VM, Teixeira MJ. Prospective randomized study comparing clinical, functional, and aesthetic results of minipterional and classic pterional craniotomies. J Neurosurg. 2015;122(5):1012–9.

    Article  PubMed  Google Scholar 

  4. Gazzeri R, Nishiyama Y, Teo C. Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxial and intraaxial tumors. Neurosurg Focus. 2014;37(4):E20.

    Article  PubMed  Google Scholar 

  5. Paladino J, Mrak G, Miklić P, Jednacak H, Mihaljević D. The keyhole concept in aneurysm surgery – a comparative study: keyhole versus standard craniotomy. Minim Invasive Neurosurg. 2005;48(5):251–8.

    Article  CAS  PubMed  Google Scholar 

  6. Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ E. Minimally invasive transpalpebral “eyelid” approach to the anterior cranial base. Neurosurgery. 2011;69(2 Suppl Operative):ons195–206; discussion 206–7.

    Google Scholar 

  7. Wilson DH. Limited exposure in cerebral surgery. J Neurosurg. 1971;34(1):102–6.

    Google Scholar 

  8. Brock M, Dietz H. The small frontolateral approach for the microsurgical treatment of intracranial aneurysms. Acta Neurochir. 1978;21:185–91.

    CAS  Google Scholar 

  9. Raza SM, Garzon-Muvdi T, Boaehene K, Olivi A, Gallia G, Lim M, Subramanian P, Quinones-Hinojosa A. The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution. Minim Invasive Neurosurg. 2010;53(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  10. Andaluz N, Romano A, Reddy LV, Zuccarello M. Eyelid approach to the anterior cranial base. J Neurosurg. 2008;109(2):341–6.

    Article  PubMed  Google Scholar 

  11. Cheng CM, Noguchi A, Dogan A, Anderson GJ, Hsu FPK, McMenomey SO, Delashaw JB. Quantitative verification of the keyhole concept: a comparison of area of exposure in the parasellar region via supraorbital keyhole, frontotemporal pterional, and supraorbital approaches. J Neurosurg. 2013;118:264–9.

    Article  PubMed  Google Scholar 

  12. Berhouma M, Jacquesson T, Jouanneau E. The fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base. Acta Neurochirurgica. 2011;153:1949.

    Article  PubMed  Google Scholar 

  13. Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg. 2013;2013:296469.

    PubMed  PubMed Central  Google Scholar 

  14. Czirják S, Szeifert GT. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery. 2001;48(1):145–50.

    PubMed  Google Scholar 

  15. Czirják S, Nyáry I, Futó J, Szeifert GT. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol. 2002;57(5):314–23.

    Article  PubMed  Google Scholar 

  16. Ramos-Zúñiga R. The trans-supraorbital approach. Minim Invasive Neurosurg. 1999;42(3):133–6.

    Article  PubMed  Google Scholar 

  17. Berhouma M, Jacquesson T, Jouanneau E. The fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base. Acta Neurochir. 2011;153(10):1949–54.

    Article  PubMed  Google Scholar 

  18. Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg. 1997;40:91–7.

    Article  CAS  PubMed  Google Scholar 

  19. Frazier CH. An approach to the hypophysis through the anterior cranial fossa. Ann Surg. 1913;57(2):145–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Eppley BL, Custer PL, Sadove AM. Cutaneous approaches to the orbital skeleton and periorbital structures. J Oral Maxillofac Surg. 1990;48:842–54.

    Article  CAS  PubMed  Google Scholar 

  21. Schwartz MS, Anderson GJ, Horgan MA, Kellogg JX, McMenomey SO, Delashaw JB Jr. Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach. J Neurosurg. 1999;91:1020–6.

    Article  CAS  PubMed  Google Scholar 

  22. Ohjimi H, Taniguchi Y, Tanahashi S, Era K, Fukushima T. Accessing the orbital roof via an eyelid incision: the transpalpebral approach. Skull Base Surg. 2000;10(4):211–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Moe K, Ramanathan D, Sekhar L, Kim L. The extended transorbital upper lid crease craniotomy: a less invasive alternative to the supraorbital craniotomy. Skull Base. 2009;19:A088.

    Article  Google Scholar 

  24. Nathal E, Gomez-Amador JL. Anatomic and surgical basis of the sphenoid ridge keyhole approach for cerebral aneurysms. Neurosurgery. 2005;56(Suppl 1):178–85.

    PubMed  Google Scholar 

  25. Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg. 2014;82(1–2):e243–56.

    Article  PubMed  Google Scholar 

  26. Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery. 2009;64:269–84. [discussion 284–286].

    PubMed  Google Scholar 

  27. Romani R, Laakso A, Kangasniemi M, Niemela M, Hernesniemi J. Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurgery. 2012;70:1504–18.

    Article  PubMed  Google Scholar 

  28. McLaughlin N, Ditzel Filho LF, Shahlaie K, Solari D, Kassam AB, Kelly DF. The supraorbital approach for recurrent or residual suprasellar tumors. Minim Invasive Neurosurg. 2011;54:155–61.

    Article  CAS  PubMed  Google Scholar 

  29. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg. 2008;108:715–28.

    Article  PubMed  Google Scholar 

  30. Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery. 2005;57(4 Suppl):242–55; discussion 242–55.

    Google Scholar 

  31. Schmidt BL, Pogrel MA, Hakim-Faal Z. The course of the temporal branch of the facial nerve in the periorbital region. J Oral Maxillofac Surg. 2001;59(2):178–84.

    Article  CAS  PubMed  Google Scholar 

  32. Mitchell P, Vindlacheruvu RR, Mahmood K, Ashpole RD, Grivas A, Mendelow AD. Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms. Surg Neurol. 2005;63(1):47–51.

    Article  PubMed  Google Scholar 

  33. Heros RC. The supraorbital “keyhole” approach. J Neurosurg. 2011;114(3):850–1.

    Article  PubMed  Google Scholar 

  34. Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol. 2003;59(3):223–7.

    Article  PubMed  Google Scholar 

  35. Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery. 1982;11:537–42.

    Article  CAS  PubMed  Google Scholar 

  36. Kabil MS, Shahinian HK. Application of the supraorbital endoscopic approach to tumors of the anterior cranial base. J Craniofac Surg. 2005;16:1070–4.

    Article  PubMed  Google Scholar 

  37. Menovsky T, Grotenhuis JA, de Vries J, Bartels RH. Endoscope-assisted supraorbital craniotomy for lesions of the interpeduncular fossa. Neurosurgery. 1999;44(1):106–10.

    Article  CAS  PubMed  Google Scholar 

  38. Owusu Boahene KD, Lim M, Chu E, Quinones-Hinojosa A. Transpalpebral orbitofrontal craniotomy: a minimally invasive approach to anterior cranial vault lesions. Skull Base. 2010;20(4):237–44.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Warren WL, Grant GA. Transciliary orbitofrontozygomatic approach to lesions of the anterior cranial fossa. Neurosurgery. 2009;64(5 suppl 2):324–9.

    PubMed  Google Scholar 

  40. Parell GJ, Becker GD. Comparison of absorbable with nonabsorbable sutures in closure of facial skin wounds. Arch Facial Plast Surg. 2003;5:488–90.

    Article  PubMed  Google Scholar 

  41. Fischer G, Stadie A, Reisch R, Hopf NJ, Fries G, Böcher-Schwarz H, van Lindert E, Ungersböck K, Knosp E, Oertel J, Perneczky A. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery. 2011;68(1 Suppl Operative):45–51; discussion 51.

    Google Scholar 

  42. Perneczky A. Surgical results, complications and patient satisfaction after supra- orbital craniotomy through eyebrow skin incision. Paper presented at: Joint Meeting mit der Ungarischen Gesellschaft fuer Neurochirurgie Deutsche Gesellschaft fuer Neurochirurgie (DGNC); April 28, 2004; Koln, Germany.

    Google Scholar 

  43. Pondé JM, Metzger P, Amaral G, Machado M, Prandini M. Anatomic variations of the frontal sinus. Minim Invasive Neurosurg. 2003;46(1):29–32.

    Article  PubMed  Google Scholar 

  44. Beretta F, Andaluz N, Chalaala C, Bernucci C, Salud L, Zuccarello M. Image-guided anatomical and morphometric study of supraorbital and transorbital minicraniotomies to the sellar and perisellar regions: comparison with standard techniques. Laboratory investigation. J Neurosurg. 2010;113:975–81.

    Article  PubMed  Google Scholar 

  45. Wiedemayer H, Sandalcioglu IE, Wiedemayer H, Stolke D. The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base. Minim Invasive Neurosurg. 2004;47(4):221–5.

    Article  CAS  PubMed  Google Scholar 

  46. Sabersky A, Alkhalili K, Darwish M, Alshyal G, Aziz KM. Minimally invasive transpalpebral “eyelid” craniotomy for anterior circulation aneurysms: experience with 71 cases. J Neurol Surg B. 2015;76:A121.

    Google Scholar 

  47. Batjer HH. Comment on Steiger HJ, Schmid-Elsaesser R, Stummer W, Uhl E: Transorbital keyhole approach to anterior communicating artery aneurysms. Neurosurgery. 2001;48:347–52.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khaled Abdel Aziz .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mao, G., Aldahak, N., Aziz, K.A. (2019). 10 Keyhole Supraorbital Craniotomy: Eyelid and Eyebrow Approaches. In: Evans, J., Kenning, T., Farrell, C., Kshettry, V. (eds) Endoscopic and Keyhole Cranial Base Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-64379-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64379-3_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64378-6

  • Online ISBN: 978-3-319-64379-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics