title: Supraorbital trans-eyebrow craniotomy and fluorescence-guided resection of fronto-basal high grade gliomas.
abstract: OBJECTIVE
  To determine the effectiveness of fluorescence-guided resection of fronto-basal high grade gliomas by using the supraorbital trans-eyebrow craniotomy.
  
  
  METHODS
  We present a single-institution experience of 6 consecutive patients presenting high grade brain glioma located on the fronto-basal area that were operated through a supraorbital trans-eyebrow craniotomy. Previous to surgery all patients were administered 20mg/kg of 5 aminolevulic acid so microscopic fluorescence-guided resection could be accomplished. Tumors were located on gyrus rectus (3 patients), medial orbital gyrus (2 patients), and anterior orbital gyrus (1 patient).
  
  
  RESULTS
  Despite the narrow surgical corridor, fluorescence was useful in all cases. Fluorescence-guided resection allowed inclusion into the margins of resection of areas previously considered as normal under white light. Complete resection was obtained in 5 patients. No neurological postoperative new deficit was observed in this series. All six cases corresponded to glioblastoma. Only one case of superficial infection with delayed wound healing was reported as complication. All patients expressed a high level of satisfaction related to cosmetic result.
  
  
  CONCLUSIONS
  Fluorescence-guided resection of fronto-basal high grade gliomas can be successfully achieved through supraorbital trans-eyebrow craniotomy. Benefits of supraorbital craniotomy in the management of fronto-basal high grade gliomas as well as usefulness of fluorescence-guided resection through a very narrow corridor are exposed.
authors: Dptment of Neurocurgery, Hospital Universitari i Politècnic la Fe, Valencia, Spain. ricprat@hotmail.com
authors: Ricardo
authors: R
authors: Prat-Acín
authors: Inmaculada
authors: I
authors: Galeano-Senabre
authors: G
authors: G
authors: Pancucci
authors: R
authors: R
authors: Evangelista
authors: A
authors: A
authors: Ayuso-Sacido
authors: C
authors: C
authors: Botella
mesh_terms: D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use; D001479:Basal Ganglia / Q000601:surgery*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D003399:Craniotomy / Q000379:methods*; D005138:Eyebrows; D005260:Female; D005625:Frontal Lobe / Q000601:surgery*; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D017060:Patient Satisfaction; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid
keywords: 5 Aminolevulic acid; Craniotomy; Fluorescence; Frontal; Glioblastoma; Supraorbital