title: Minimal invasive trans-eyelid approach to anterior and middle skull base meningioma: a preliminary study of Shanghai Huashan hospital.
abstract: Transpalpebral or trans-eyelid approach is a modified trans-orbital access to lesions of anterior cranial fossa and sellar region. But whether this approach is also suitable for tumors extending laterally to the temporal lobe or middle cranial fossa is not clarified. We would like to share our experiences from the cadaveric anatomy study to clinical operations. We used 5 cadavers to study trans-eyelid approaches in a step-by-step fashion. And then assisted by an experienced ophthalmologist for incisions, we treated 3 female patients via this approach: One with spheno-orbital meningioma, one with sellar tuberculum meningioma, and the other with medial sphenoidal wing meningioma. After studying the cadavers, we made several revisions to the previously reported approach: 1) move the incision close to the edge of the eyelid, which resembled the double-eyelid incision. 2) A vascularized periosteum flap was dissected for repairing the opened frontal sinus and reconstruction of the skull base. 3) The dura was sutured up with a slice of temporalis muscle. Then we treated 3 patients by this approach. All tumors were totally resected as Simpson Grade I. Complications included orbital apex syndrome and transient oculomotor paralysis because of tumor invasion into orbit and cavernous sinus. No cerebrospinal fluid leakage. We find that trans-eyelid approach is suitable for lesions not only at anterior cranial base or sellar region, but also extending to middle cranial base, especially around sphenoidal wings within 2 cm range or spheno-orbital region. Thus, we propose whether it appropriate to nominate this approach as 'trans-eyelid pterional approach', since it may treat some anterior and middle cranial fossa lesions with a mini-craniotomy around pterion.
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Dai-Jun
authors.initials: DJ
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Mao
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhong
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Ming-Zhe
authors.initials: MZ
authors.lastname: Zheng
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Hai-Liang
authors.initials: HL
authors.lastname: Tang
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Hong-Da
authors.initials: HD
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Xian-Cheng
authors.initials: XC
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Liang-Fu
authors.initials: LF
authors.lastname: Zhou
authors.affiliation: Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University Shanghai, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Gong
keywords: Transeyelid; meningioma; minimal invasive neurosurgery; skull base