title: Applying Craniofacial Principles to Neurosurgical Exposures in Cerebrovascular Aneurysm Repair.
abstract: The subspecialty of craniofacial surgery emphasizes skeletal exposure, preservation of critical structures, and provision of a superior cosmetic result. In recent decades, an emphasis on minimally invasive neurosurgical exposure has paved the way for increased collaboration between neurosurgeons and craniofacial surgeons.The 1990s saw the growing popularity of an eyebrow incision for orbital roof craniotomies in neurosurgery to address lesions in the anterior skull base. Disadvantages of this approach included conspicuous scarring above the brow skin, risk of injury to the frontal branch of the facial nerve, and numbness from supraorbital or supratrochlear nerve transection.A transpalpebral approach was first described in 2008 in the neurosurgical literature. An approach familiar to the craniofacial surgeon, transpalpebral exposure is used for zygomaticomaxillary complex fractures as well as aesthetic brow and periorbital surgery.In conjunction with neurosurgery, the authors have applied craniofacial principles to address the major pitfalls of the transpalpebral craniotomy. The authors present their patient series experience. Hopefully, in the future, other institutions will have increased collaboration between craniofacial surgeons and neurosurgeons.
authors.affiliation: *New York University Langone Medical Center, New York, NY †Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Alperovich
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Frey
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Potts
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
authors.forename: David A
authors.initials: DA
authors.lastname: Staffenberg
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*