title: Minimally invasive transpalpebral "eyelid" approach to the anterior cranial base.
abstract: BACKGROUND
  Supra orbital frontal minicraniotomy is one of the most commonly used minimally invasive approaches for anterior cranial fossa lesions.
  
  
  OBJECTIVE
  To describe our experience with the transpalpebral "eyelid" incision to obtain access to the anterior cranial fossa.
  
  
  METHODS
  We describe the approach and technique of the transpalpebral eyelid incision in a step-by-step fashion and discuss the results of 40 cases for which the eyelid incision was used. We retrospectively reviewed the charts of these patients to analyze outcomes with regard to opening and closing time, length of hospital stay, residual aneurysm or Simpson grade for resection, complications, and cosmetic result.
  
  
  RESULTS
  We treated 31 anterior circulation aneurysms (28 unruptured and 3 ruptured), 7 anterior skull base meningiomas, 1 frontal low-grade glioma, and 1 frontal cavernoma using the transpalpebral incision. Opening time was about 45 to 60 minutes, and closure time from dura to skin was about 45 to 60 minutes. The hospital length of stay was similar to that in our open craniotomy cases. No residual aneurysm was demonstrated in the follow-up studies of all 31 aneurysms. Simpson grade I resection was achieved in 6 meningiomas. Complications included 1 postoperative eyelid hematoma, 2 postoperative infections, and a subclinical stroke discovered on postoperative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients.
  
  
  CONCLUSIONS
  The transpalpebral approach provides dissection in natural anatomical planes, affords preservation of the frontalis muscle, avoids injury to nerve VII branches, and results in an excellent cosmetic outcome.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Drexel College of Medicine, Pittsburgh, Pennsylvania 15212, USA. kaziz@wpahs.org
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Abdel Aziz
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhatia
authors.forename: Mohammed Hammad
authors.initials: MH
authors.lastname: Tantawy
authors.forename: Raymond
authors.initials: R
authors.lastname: Sekula
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Keller
authors.forename: Sebastien
authors.initials: S
authors.lastname: Froelich
authors.forename: Erik
authors.initials: E
authors.lastname: Happ
mesh_terms: D000328:Adult; D000368:Aged; D035262:Cranial Fossa, Anterior / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019292:Skull Base Neoplasms / Q000601:surgery*