Introduction: Concept of minimally invasive approaches for anterior cranial fossa has been evolving during the past two decades. Supra orbital frontal mini-craniotomy with or without orbitotomy is the commonly utilized approached.
Methods: We describe the trans-palpebral eyelid incision which utilizes natural upper eyelid crease to obtain exposure for anterior circulation aneurysms through subfrontal-supraorbital corridor. The eyelid approach reduce risk of injury to frontalis branch of facial nerve. We will review our experience with 71 anterior circulation aneurysms.
Results: Extracranial drilling of the greater sphenoid wing exposes the frontal dura, temporal dura, and peri-orbita (spheno-orbital key-hole). One piece fronto-orbital craniotomy is performed in all cases with bone flap about 2.5 cm height. Optic foramnotomy and anterior clinoidectomy added when indicated. After dura open panoramic view of anterior cranial fossa floor achieved from the contralateral to epsilateral oculomotor nerve. We are describing the approach, technique in step-by-step fashion, discuss the results of our 71 cases . 3/71 complications (eyelid hematoma, superficial infection, CSF leak, delayed opst-operative cerebellar hematoma.
Conclusions: The transpalpebral approach provides dissection in natural anatomical planes, preserving frontalis muscle, avoids injury to VII nerve branches, and results in excellent cosmetic outcome
Patient Care: 1. Less invasive procedure 2. Soft tissue (temporalis muscle) preservation 3.Excelent cosmetic outcome
Learning Objectives: 1.Understand the extent if exposure gained by this unique approach 2. Applications and limitations of the approach 3. Value of cosmetic outcome in modern neurosurgery
References: 1. Minimally invasive transpalpebral "eyelid" approach to the anterior cranial base. Abdel Aziz KM, Bhatia S, Tantawy MH, Sekula R, Keller JT, Froelich S, Happ Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons195-206; discussion 206-7. doi: 10.1227/NEU.0b013e31821c3ea3. 2. Transpalpebral orbitofrontal craniotomy: a minimally invasive approach to anterior cranial vault lesions. Owusu Boahene KD, Lim M, Chu E, Quinones-Hinojosa A. Skull Base. 2010 Jul;20(4):237-44. doi: 10.1055/s-0030-1249247.