Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy...Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.展开更多
Background:Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis,injury to the facial nerve,and unnecessary cortical exposure.As an alternative to the classical pterional a...Background:Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis,injury to the facial nerve,and unnecessary cortical exposure.As an alternative to the classical pterional approach for such surgeries,we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries.Material and methods:In the mini-temporal incision design,the frontal end of the incision never surpassed the hairline at the level of temporal line,and a one-layer skin-galea-muscle flap was detached from the cranium,effectively avoiding the injuries of facial nerve.The surgical bone window was completely located underneath the temporalis muscle,allowing it to be completely repositioned postoperatively.Results:We demonstrated the application of mini-temporal approach in a variety of temporal region tumors,which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex,temporalis,and facial nerve.There were no postoperative complications related to extra-temporal cortical damage,atrophy of temporalis,or injury to the facial nerve.Conclusion:The mini-temporal approach can effectively shorten the time of craniotomy and closure,decrease the size of bony removal,increase the restoration of temporalis during closure,and lower the chance of facial nerve injury.Therefore,it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury,which fully embodies the minimally invasive principle in neurosurgery.展开更多
文摘Background: The eyebrow supraorbital keyhole approach could be considered a modified minimally invasive model for the classic pterional subfrontal approach in which an eyebrow incision and supraorbital mini craniotomy are performed for exposure of the anterior cranial fossa corridor. Methods: This study was retrospectively conducted on twenty four patients, age ranging from 20 to 65 years old, with anterior cranial fossa lesions who were meeting the eligibility criteria for eyebrow craniotomy in the period from August 2019 to January 2023. These patients were operated through eyebrow supraorbital approach in which microscopic endoscopic assisted technique were used. Extent of resection, clinical and cosmetic outcomes and complication incidence were assessed. Results: We included the twenty four patients who met inclusion criteria (17 females and 7 males) their ages ranged from 20 to 65 years. The most common pathology was meningioma in 19 patients. Two patients experienced supraorbital loss of sensation and only one patient experienced palsy of frontalis branch of facial nerve. Frontal sinus was breached in 3 patients with no patient experienced postoperative CSF leak. Total excision was accomplished for 23 patients. Four patients who had preoperative visual compromise, improvement of visual acuity and field defects was observed in 3 patients. No major intraoperative complications occurred. All patients filled cosmetic satisfaction questionnaire during their outpatient visits. For the eyebrow supraorbital approach, no incision related intolerable pain, no craniotomy defects or irregularities, no cosmetic complaints nor limitation of jaw opening were reported, and only minor symptoms in the form of limited eyebrow elevation, swelling and numbness in the forehead. Conclusions: The eyebrow craniotomy could be used safely as a more cosmetic and minimally invasive approach for a variety of anterior cranial fossa lesions. Endoscopic assistance has been found very useful for deeply seated lesions and hidden residuals with minimal brain retraction which couldn’t be accessed easily through microscopic field solely. Endoscopic assisted eyebrow supraorbital keyhole approach could be performed on a wider scale with great results but requires good selection of cases and more practice to expertise the needed skills.
基金Matthias Mäurer and Marcel Kamp were funded by the Stifterverband in cooperation with the Thuringian Ministry of Economics,Science and Digital Society within the framework of the"Fellowship for Innovations in Digital University Teaching"(GZ:5508/78-15-25)Matthias Mäurer was funded by the Deutsche Forschungsgemsinschaft(DFG,German Research Foundation)Clinician Scientist Program OrganAge(funding number 413668513)by the Interdisciplinary Center of Clinical Research of the Medical Faculty Jena.Irina Mäurer was supported by funding from the Foundation"Else-Kröner-Fresenius-Stiftung"within the Else Kröner Research School for Physicians"AntiAge".
文摘Background:Classical pterional appoach for temporal surgeries may cause atrophy and dysfunction of temporalis,injury to the facial nerve,and unnecessary cortical exposure.As an alternative to the classical pterional approach for such surgeries,we hereby describe an mini-temporal approach which reduces these risks and proven to be practical in neurological surgeries.Material and methods:In the mini-temporal incision design,the frontal end of the incision never surpassed the hairline at the level of temporal line,and a one-layer skin-galea-muscle flap was detached from the cranium,effectively avoiding the injuries of facial nerve.The surgical bone window was completely located underneath the temporalis muscle,allowing it to be completely repositioned postoperatively.Results:We demonstrated the application of mini-temporal approach in a variety of temporal region tumors,which can be applied to complete successful resective surgeries while effectively reducing injuries to extra-temporal cortex,temporalis,and facial nerve.There were no postoperative complications related to extra-temporal cortical damage,atrophy of temporalis,or injury to the facial nerve.Conclusion:The mini-temporal approach can effectively shorten the time of craniotomy and closure,decrease the size of bony removal,increase the restoration of temporalis during closure,and lower the chance of facial nerve injury.Therefore,it improves cosmetic outcomes and reduces the risk of unintentional extra-temporal cortical injury,which fully embodies the minimally invasive principle in neurosurgery.
