Abstract
Background
This case report describes a transadnexal transorbital roof approach to the anterior cranial fossa to treat an epidural abscess in a patient who had previously undergone extensive craniofacial reconstruction secondary to fibrous dysplasia. A standard frontal craniotomy or even a supraciliary craniotomy would have been burdensome due to the positioning of the porous polyethylene implant as well as extensive scar tissue and adhesions from prior surgical procedures.
Methods
We performed a retrospective review of the case of a 15-year-old male with an epidural abscess treated at a university hospital.
Results
The patient tolerated the procedure well with no postoperative complications. Surgical operative time was approximately 1.5 h with minimal blood loss and the patient was discharged on postoperative day 2. Six weeks after antibiotic therapy (intravenous ampicillin/sulbactam, 2,000 mg q.i.d. for 6 days total), an MRI showed complete resolution of the epidural abscess. At that time the patient had no visual changes, extraocular muscle dysfunction, headaches, periorbital cellulitis, or further seizures and is on no antiepileptic therapy.
Conclusion
Minimally invasive approaches to treat complex problems in certain circumstances can yield excellent results and limit morbidity encountered by more extensive procedures. In the future, more formal studies with a larger subset of patients will help determine what role these approaches will ultimately have.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
This is a preview of subscription content, log in via an institution to check access.
References
Zimmer LA, Theodosopoulos PV (2009) Anterior skull base surgery: open versus endoscopic. Curr Opin Otolaryngol Head Neck Surg 17(2):75–78
Moe KS, Bergeron CM, Ellenbogen RG (2010) Transorbital neuroendoscopic surgery. Neurosurgery 67(3 Suppl Operative):ons16–28
Ciporen JN, Moes KS, Ramanathan D et al (2010) Multiportal endoscopic approaches to the central skull base: a cadaveric study. World Neurosurg 73(6):705–712
Beretta F, Andaluz N, Chalaala C et al (2010) Image-guided anatomical and morphometric study of supraorbital and transorbital minicraniotomies to the sellar and perisellar regions: comparison with standard techniques. J Neurosurg 113(5):975–981
Noggle JC, Scubba DM, Nelson C et al (2008) Supracilliary keyhole craniotomy for brain abscess debridement. Neurosurg Focus 24(6):E11
Abdel Aziz KM, Bhatia S, Tantawy MH et al (2011) Minimally invasive transpalpebral “eyelid” approach to the anterior cranial base. Neurosurgery 69(2 Suppl Operative):ons195–206 discussion 206-207
Conflict of interest
The authors have no personal, financial, or institutional interest in any of the materials or devices described in this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rajappa, P., Krass, J., Parakh, S. et al. An Aesthetic Approach to the Anterior Cranial Fossa: The Endoscopic Transadnexal Transorbital Roof Method. Aesth Plast Surg 38, 399–403 (2014). https://doi.org/10.1007/s00266-014-0284-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-014-0284-8