S1-18 NOVEL TRANSPALPEBRAL “EYELID” APPROACH FOR SUPRAORBITAL FRONTAL CRANIOTOMY AND ACCESS TO THE ANTERIOR CRANIAL FOSSA

Abstract

Introduction: The transpalpebral “eyelid” approach is a novel alternative to the traditional incisions for supraorbital frontal craniotomy and access to the anterior cranial fossa. Using the natural skin folds of the eyelid, the transpalpebral incision mitigates visible scars to improve post-operative aesthetic outcomes. While this type of approach has been described in the neurosurgery literature, this is the first report of such a surgical technique in the plastic and reconstructive surgery literature for accessing the anterior cranial fossa. Herein, we elucidate our unique surgical technique and results for this approach to the anterior cranial fossa. Methods: A retrospective review was performed of patients who underwent supraorbital frontal craniotomy using an anterior skull base approach with transpalpebral exposure over seven years by a single plastic surgeon (D.A.S.). Surgical techniques, medical co-morbidities, intra-operative complications, and long-term complications were assessed. Pre- and post-operative imaging were evaluated. Results: Nineteen patients (mean age 52±12 years, 52% male, 48% female) underwent supraorbital frontal craniotomy using an anterior skull base approach with upper transpalpebral exposure. In terms of operative indications, 80% (15) had anterior communicating aneurysms with a mean aneurysm size of 5.36±1.91 mm, 10% (2) had meningiomas, 5% (1) had a dural fistula, and 5% (1) had an orbital hemangioma. Notably, 58% (11) had a smoking history. No intra-operative complications were encountered, and no cases were converted to traditional open approaches. Mean length of hospital stay was 3.3±1.5 days. Post-operative imaging revealed no residual or recurrent aneurysms, meningiomas, fistulas, or hemangiomas. Mean follow up time was 47.1±28.4 months. Long-term complications were limited to two patients requiring re-operation for aesthetic considerations related to palpable hardware with no further sequelae. Specifically, one patient had removal of right cranial hardware and cranioplasty with bone paste as well as temporalis muscle flap advancement, and one patient had removal of left cranial hardware and cranioplasty with bone cement. No long-term neurological complications or infections occurred. Conclusion: In conclusion, this transpalpebral technique is an excellent, minimally invasive, and innovative alternative to approach lesions of the anterior cranial fossa. This transpalpebral approach provides dissection in well-defined anatomical planes, affords preservation of the frontalis muscle, avoids injury to the facial nerve branches, and yields superior aesthetic outcomes to traditional craniotomy incisions.