title: The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution.
abstract: BACKGROUND
  The supraorbital craniotomy was initially described as a minimally invasive means to target extra-axial lesions in the anterior cranial fossa and sellar/parasellar region. Since its initial description, various modifications have been described. We report our recent experience with this approach (and its modifications) for not only extra-axial but also intra-axial neoplastic pathology.
  
  
  METHODS
  Based on patient pathology and anatomic considerations, one of two approaches was performed: supraorbital craniotomy through an eyebrow incision or a combined orbital osteotomy and supraorbital craniotomy through an eyelid incision.
  
  
  RESULTS
  This technique was performed on twenty-eight consecutive patients. Intra-axial pathology ranged from anaplastic astrocytoma to metastasis while extra-axial lesions included meningiomas and skull-based metastases. Excellent lesion resection was achieved in the majority of patients. Complications were infection (2 patients) and CSF leak.
  
  
  CONCLUSIONS
  The supraorbital craniotomy and its modifications provide an ideal anterior subfrontal approach through which a wide variety of pathology can be approached. This technique has particular considerations in comparison to traditional cranial base approaches that must be taken into account before it is utilized.
authors.affiliation: The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Raza
authors.forename: T
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.forename: K
authors.initials: K
authors.lastname: Boaehene
authors.forename: A
authors.initials: A
authors.lastname: Olivi
authors.forename: G
authors.initials: G
authors.lastname: Gallia
authors.forename: M
authors.initials: M
authors.lastname: Lim
authors.forename: P
authors.initials: P
authors.lastname: Subramanian
authors.forename: A
authors.initials: A
authors.lastname: Quinones-Hinojosa
mesh_terms: D000236:Adenoma / Q000601:surgery; D001254:Astrocytoma / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery; D003397:Craniopharyngioma / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004954:Esthetics; D005138:Eyebrows; D005143:Eyelids; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000601:surgery; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome