Supraorbital Keyhole Approach for Excision of Tuberculum Sellae Meningiomas

Abstract

Introduction: The main aim in surgery is to achieve the greatest therapeutic effect while causing the least iatrogenic injury. The evolution of microsurgical techniques with refined instrumentation and the enormous development of diagnostic tools enable neurosurgeons to treat different lesions through limited and specific keyhole approaches. The concept of keyhole surgery is based on careful study of diagnostic images to determine the anatomic windows that provide access to the lesion. Methods: During a 16-year period, from June 1994 to December 2010, 62 patients with tuberculum sellae meningiomas were treated using a supraorbital keyhole approach and endoscopic-assisted microsurgical technique. The most frequent presenting symptom was visual disturbance. Of the 28 patients with visual disturbances, 60% had marked visual improvement, 24% had no changes in visual function, and 16% had worsening of vision postoperatively. Results: Complete removal was achieved in 93% of cases. The postoperative complications associated with the approach were supraorbital hypoesthesia in three patients, palsy of the frontal branch of the facial nerve in two cases, hyposmia in one patient, wound-healing disturbances in one case, and subcutaneous CSF collection and leak in one patient. Conclusion: The supraorbital craniotomy allows a wide exposure of deep-seated intracranial lesions. It offers equal surgical possibilities with less approach-related morbidity owing to limited exposure of the cerebral surface and minimal brain retraction, contributing to improved postoperative results and shortened hospitalization times. The short skin incision within the eyebrow and careful soft tissue dissection result in a pleasing cosmetic outcome.