title: Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors.
abstract: OBJECTIVE
  The supraorbital eyebrow approach is a minimally invasive technique that offers wide access to the anterior skull base region and parasellar area through asubfrontal corridor. The use of neuroendoscopy allows one to extend the approach further to the pituitary fossa, the anterior third ventricle, the interpeduncular cistern, the anterior and medial temporal lobe, and the middle fossa. The supraorbital approach involves a limited skin incision, with minimal soft-tissue dissection and a small craniotomy, thus carrying relatively low approach-related morbidity.
  
  
  METHODS
  All consecutive patients who underwent the endoscopic supraorbital eyebrow approach were retrospectively analyzed for lesion location, pathology, length of stay, complications, and cosmetic results.
  
  
  RESULTS
  During a 56-month period, 97 patients (mean age 58.5 years) underwent an endoscopic eyebrow approach to resect extra- and intraaxial brain lesions. The most common pathologies treated were meningiomas (n = 41); craniopharyngiomas (n = 22); dermoid tumors (n = 7); metastases (n = 4); gliomas (n = 3); and other miscellaneous frontal, parasellar, and midbrain (n = 23) lesions. The median length of postoperative hospital stay was 2.7 days (range 1-8 days). In 82 patients a total removal of the lesion was performed, while in 15 patients a near-total or subtotal removal was achieved. There were no postoperative hematomas, cerebrospinal fluid leaks, or severe neurological deficits, with the exception of 2 cases of visual deterioration and 1 case each of meningitis, stroke, and third cranial nerve paresis. Other complications directly related to the approach included 2 cases of skin burn as a direct result of heat transmission from the microscope light, 1 case of right frontal palsy, 2 cases of frontal numbness, and 1 case of bone remodeling 1 year after surgery.
  
  
  CONCLUSIONS
  The endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive approach to remove extra- and intraaxial anterior skull base, parasellar, and frontal lesions, promoting a rapid recovery and short hospital stay. The location of the eyebrow incision demands a meticulous cosmetic closure, but, with proper technique, cosmetic results are excellent.
authors.affiliation: Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gazzeri
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Charles
authors.initials: C
authors.lastname: Teo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications; D055815:Young Adult
keywords: DNET = dysembryoplastic neuroepithelial tumor; VASC = visual analog scale for cosmesis; brain tumor; craniopharyngioma; endoscopy; eyebrow approach; meningioma; subfrontal craniotomy; supraorbital approach