title: Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision.
abstract: OBJECTIVE
  The supraorbital approach through an eyebrow incision offers the opportunity to access a wide variety of lesions of the anterior, middle, and even the posterior fossa. The minimally invasive keyhole craniotomy limits brain exploration and retraction and offers the potential for improved surgical outcomes and reduced approach-related complications. Patient satisfaction, however, has not yet been reported in the literature.
  
  
  METHODS
  From January 2002 through December 2011, the lead author (R.R.) used a supraorbital approach through an eyebrow incision for 418 patients with cerebral aneurysms, brain tumors or cystic lesions, and other miscellaneous pathological conditions. For 408 of these patients, a detailed retrospective case note review was conducted to extract data on surgical outcomes and complications, and 375 patients completed a follow-up patient satisfaction questionnaire.
  
  
  RESULTS
  During the early perioperative period, 8 patients died (overall mortality rate 2.0%). Among patients surveyed, the overall level of satisfaction was high. Patients rated pain from the scar and headache on a scale from 1 to 5 (1 = no pain, 5 = severe pain) as follows: pain was a score of 1 for 289 patients (77.0%), 2 for 46 (12.3%), 3 for 22 (5.9%), 4 for 12 (3.2%), and 5 for 6 (1.6%). Patients also rated cosmetic outcome on a scale from 1 to 5 (1 = very pleasant, 5 = very unpleasant) as follows: outcome was a score of 1 for 315 patients (84.0%), 2 for 33 (8.8%), 3 for 14 (3.7%), 4 for 10 (2.7%), and 5 for 3 (0.8%). Postoperative chewing difficulty was reported for 8 patients (8 [2.1%] temporary, 0 permanent); palsy of the frontal muscle for 21 patients (5.6%; 13 [3.5%] temporary, 8 [2.1%] permanent); frontal hypesthesia for 31 patients (8.3%; 18 [4.8%] temporary, 13 [3.4%] permanent); and hyposmia for 11 patients (2.9%; 3 [0.8%] temporary, 8 [2.1%] permanent).
  
  
  CONCLUSIONS
  The supraorbital approach to the anterior, middle, and posterior fossae through an eyebrow incision offers a favorable rate of approach-associated surgical complications and high patient satisfaction with cosmetic outcome.
authors.affiliation: Centre for Endoscopic and Minimally Invasive Neurosurgery, Klinik Hirslanden, Zurich, Switzerland;
authors.forename: Robert
authors.initials: R
authors.lastname: Reisch
authors.forename: Hani J
authors.initials: HJ
authors.lastname: Marcus
authors.forename: Michael
authors.initials: M
authors.lastname: Hugelshofer
authors.forename: Nicolas Olmo
authors.initials: NO
authors.lastname: Koechlin
authors.forename: Axel
authors.initials: A
authors.lastname: Stadie
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Kockro
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery; D003357:Cosmetic Techniques; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005138:Eyebrows; D005158:Facial Paralysis / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology; D015994:Incidence; D002532:Intracranial Aneurysm / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009915:Orbit / Q000601:surgery*; D010149:Postoperative Pain / Q000453:epidemiology*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: eyebrow skin incision; minimally invasive neurosurgery; patient satisfaction; supraorbital approach; surgical complications; surgical outcome; surgical technique