How I do it: The expanded trans/supraorbital approach for large space-occupying lesions of the anterior fossa.
The supraorbital rim often interferes with the required upward movement of the instruments for resection of large frontal-lobe tumours through a classic supraorbital craniotomy. Here, we present the expanded trans/supraorbital approach to overcome these limitations.



After an eyebrow skin incision, a one-piece bone flap was created incorporating the orbital rim and roof. Basal extension of the craniotomy allowed for a better intracranial visualisation with improved manoeuvrability and angulation of the instruments without using brain retraction.



This approach poses a feasible alternative to large frontal craniotomies for frontal-lobe tumours, for which a regular supraorbital craniotomy is insufficient.
ENDOMIN-Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden Clinic, Witellikerstr. 40, 8032, Zurich, Switzerland. ak.hickmann@gmail.com.
Anne-Katrin
AK
Hickmann
Department of Anaesthesiology and Intensive Care Medicine, Hirslanden Clinic, Zurich, Switzerland.
Britta-Jacqueline
BJ
Gaida
ENDOMIN-Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden Clinic, Witellikerstr. 40, 8032, Zurich, Switzerland.
Robert
R
Reisch
D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005138:Eyebrows; D006801:Humans; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D013524:Surgical Flaps / Q000601:surgery; D013525:Surgical Instruments
Anterior fossa; Brain tumour; Endoscopy; Minimally invasive; Supraorbital