Dr. Jho's Side-of-the-Eyebrow Incision Skull Base Surgery: Epidermoid, Meningioma, Craniopharyngioma, Parasellar Tumor, Cerebral Aneurysm: Superolateral Orbital Craniotomy: Minimally Invasive Skull Base Surgery For Brain Tumors And Cerebral Aneurysms

Hae Dong Jho, M.D., Ph.D.

"Band-aid" Brain surgery for meningioma, epidermoid, craniopharyngioma, parasellar tumors and cerebral aneurysms

Facts About This Surgery

• Provides direct access to tumors and aneurysms located laterally at the anterior skull base
• Is minimally invasive because it utilizes a smaller hole in the bone as well as a smaller incision
• Is innovative because it does not require the use of brain retractors which minimizes the risk of brain damage
• Does not sacrifice exposure or outcome by being less invasive
• Provides an alternative to the conventional procedures that often utilize extensive bone and skin flaps

Discussion

Utilizing a small hole in the skull above and to the side of the eyebrow, this minimally invasive skull base procedure provides a direct "shortcut" approach to tumors and aneurysms. Nick-named band-aid surgery because a band-aid type dressing is used to cover the postoperative incision, this surgery does not sacrifice exposure for the surgeon while providing the benefits of being less invasive. Tumors and aneurysms located laterally at the anterior skull base are reached through a two inch skin incision and a small bone hole called a craniotomy. It is referred to as a superolateral craniotomy because the approach is above the eye and slightly to the side. Brain retractors are not used which reduces risk. Positive feedback has been received concerning cosmetic healing of incisions.

Definitions

orbital - refers to the bony cavity in the skull that contains the eyeball

craniotomy - an operation producing an opening in the cranium

Images

            

Preoperative MRI scan, coronal and sagittal views, reveals a tuberculum sellar meningioma which caused a visual disorder in this patient.

            

Postoperative MRI scan, coronal and sagittal views, demonstrate complete removal of the tumor via an eyebrow approach.

                

A photo demonstrates a postoperative bandage after total resection of the tumor (left). (Right top) Preoperative visual field test results depict a visual deficit, seen as the darkened area, and caused by tumor compression on optic nerve. (Right lower) After tumor was resected via an eyebrow approach, a postoperative visual field demonstrates complete recovery of the visual field.

            

A preoperative cerebral arteriogram shows a basilar tip aneurysm (left) and a postoperative arteriogram, following aneurysm clipping via a superolateral orbital craniotomy, confirms successful clipping (right).

A patient with a healed superolateral orbital craniotomy incision line (arrows)

Reference

Jho HD: Superolateral orbital approach via a lateral eyebrow incision as a simplified skull base approach. In Rengachary SS, Wilkins RJ (eds), Neurosurgical Operative Color Atlas, Williams and Wilkins (in press)