Supraorbital eyebrow craniotomy for removal of intraaxial frontal brain tumors: a technical note.
OBJECTIVE
To present the utility and selection criteria for the supraorbital (SO) craniotomy, an approach commonly used to remove extraaxial tumors such as meningiomas and craniopharyngiomas, to resect intraaxial frontal brain lesions.


METHODS
All consecutive patients who underwent a SO craniotomy for an intraaxial lesion were retrospectively analyzed for lesion location, pathology, extent of resection, operative times, length of stay, and complications.


RESULTS
During 28 months, 10 patients (mean age, 67.6 years; 7 women) underwent 11 SO procedures to resect intraaxial brain lesions. Pathologies included metastatic carcinoma (n = 7), glioma (n = 2), and radiation necrosis (n = 1). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near-total removal was achieved in 80% of the cases. Median length of hospital stay was 3 days (range, 2-6 days); it was 2 days for patients admitted electively for SO craniotomy. There were no new neurologic deficits, postoperative hematomas, or cerebrospinal fluid leaks.


CONCLUSIONS
The SO "eyebrow" craniotomy is a safe and effective keyhole method to remove intraaxial frontal lobe lesions, particularly lesions of the frontal pole and orbitofrontal region, allowing for minimal disruption of normal brain parenchyma and promoting a rapid recovery and short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intraaxial tumors can also be effectively accessed via this route with excellent clinical outcomes.
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Leo F S
LF
Ditzel Filho
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Nancy
N
McLaughlin
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Damien
D
Bresson
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Domenico
D
Solari
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Amin B
AB
Kassam
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA. Electronic address: kellyd@jwci.org.
Daniel F
DF
Kelly
D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000473:pathology / Q000601:surgery*; D005910:Glioma / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
Frontal lobe; Intraaxial; Keyhole craniotomy; Length of stay; Metastatic brain tumor; Supraorbital craniotomy