A Fully Endoscopic Supraorbital Suprafrontal Approach to Frontal and Frontoparietal Convexity/Parasagittal Meningiomas

Abstract

Traditional approaches, via open transcranial techniques to access meningiomas of the frontoparietal convexity often require relatively large craniotomies and excessive extra and intracranial surgical dissection. Thus, creating potential disfigurement and morbidity attributed to the approach itself, which is ultimately translated into longer operative times, more blood loss, increased postoperative discomfort, and long-term convalescence. We report our experience with a minimally invasive supraorbital suprafrontal endsoscopic approach through the eyebrow that we used in resection of 2 (convexity and middle parasagittal) meningiomas. Two men, aged 40 and 52 years, with frontoparietal convexity meningioma and parasagittal meningioma (middle third), respectively, were operated upon via a fully endsoscopic supraorbital suprafrontal approach using a 2×2 cm keyhole craniotomy. Complete tumor removal was accomplished in both cases with no postoperative complications and minimal postoperative discomfort. The cosmetic outcome was excellent and both patients were discharged home within 48 hours of their operation. This preliminary experience demonstrates the feasibility of resecting frontoparietal convexity/parasagittal meningiomas using endoscopic techniques. The endoscope with its superior visibility and the approach being a more targeted one, has allowed both the approach and resection to be performed with minimal disturbance to the surrounding brain tissue. Therefore, we believe that our experience with the reported technique does not only advocate the expanding use of the supraorbital approach as a minimally invasive alternative for open craniotomies, but also as a more anatomic alternative leading to superior results and surgical outcomes.