The transconjunctival transorbital approach: a keyhole approach to the midline anterior skull base.
OBJECTIVE
To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision.


METHODS
The authors retrospectively reviewed their clinical experience with this approach in the management of benign cranial base pathology. Preoperative imaging, intraoperative records, hospitalization charts, and postoperative records were reviewed for relevant data.


RESULTS
During the period 2009-2011, six patients underwent a transconjunctival craniotomy performed by a neurosurgeon and otolaryngologist-head and neck surgeon working together. The indications for surgery were esthesioneuroblastoma in one patient, juvenile angiofibroma in one patient, Paget disease in one patient, and recalcitrant cerebrospinal fluid leaks in three patients. Three patients had prior cranial base surgery (either open craniotomy or an endonasal approach) done at another institution. The mean length of stay was 3.8 days; mean follow-up was 6 months. Surgery was considered successful in all cases (negative margins or no leak recurrence); diplopia was noted in one patient postoperatively.


CONCLUSIONS
The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
Department of Neurosurgery, The Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Shaan M
SM
Raza
Alfredo
A
Quinones-Hinojosa
Michael
M
Lim
Kofi D Owusu
KD
Boahene
D000293:Adolescent; D000328:Adult; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D002648:Child; D003228:Conjunctiva / Q000033:anatomy & histology*; D035262:Cranial Fossa, Anterior / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004844:Epistaxis / Q000209:etiology; D018304:Esthesioneuroblastoma, Olfactory / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D038361:Neuronavigation; D009915:Orbit / Q000033:anatomy & histology*; D010001:Osteitis Deformans / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery; D012189:Retrospective Studies; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult