Eyebrow craniotomy for anterior skull base lesions: how I do it
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HOW I DO IT - NEUROSURGICAL TECHNIQUES
Eyebrow craniotomy for anterior skull base lesions: how I do it Zsolt Zador & Kanna Gnanalingham
Received: 8 September 2012 / Accepted: 25 October 2012 # Springer-Verlag Wien 2012
Abstract Background The eyebrow craniotomy is a less invasive alternative approach for accessing anterior skull base lesions, compared to traditional and more extensive exposures. We give a stepwise description of this minimally invasive technique with discussion on the indications, limitations and key aspects of perioperative management. Methods Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion. The eyebrow incision should spare the medial and posterolateral neural structures. Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the “keyhole effect” for accessing a larger target. Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. Conclusion The eyebrow craniotomy may be safely used as a minimally invasive approach for a variety of anterior skull base lesions. There is an operative learning curve and some types of pathologies are easier to approach by this technique than others.
Electronic supplementary material The online version of this article (doi:10.1007/s00701-012-1552-5) contains supplementary material, which is available to authorized users. Z. Zador : K. Gnanalingham Department of Neurosurgery, Manchester Skull Base Unit, Salford Royal Foundation Trust (SRFT), Manchester, UK K. Gnanalingham (*) Department of Neurosurgery, Manchester Skull Base Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK e-mail: [email protected]
Key points • The eyebrow craniotomy is an alternative less invasive approach for accessing anterior skull base lesions • Positioning of the head and planning the surgical corridor are dictated by the nature, site and size of the target lesion • Microsurgical strategy is based on opening up the basal cisterns and respecting the distorted neurovascular anatomy. • Selective use of brain retractor and angulation of the operative microscope enable the surgeon to make use of the “keyhole effect” for accessing a larger target • Perioperative measures are in part dictated by the nature of the pathology, involvement of the optic apparatus and changes to pituitary function. • There is an operative learning curve and some types of pathologies are easier to approach by this technique than others. Keywords Eyebrow craniotomy . Keyhole approach . Anterior skull base
Introduction Minimally invasive transcranial approaches have evolved along the concept of creating the smallest and least destructive surgical corridor, while maintaining optimal access to the target area. One of the most frequently used variant is the eyebro
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