Anterior cranial fossa lesions treated by a minimally invasive supraorbital approach

Introduction. The supraorbital craniotomy was initiallly described as a minimally invasive mean to targetextra-axial lesions in the anterior cranial fossa and sel-lar/parasellar region. With adaptable variations, it isalso possible to approach intra-axial lesions.Object. We report our recent experience in the treat-ment of extra- and intra-axial lesions.Material and Methods. Three illustrative cases are pre-sented in which a supraorbital approach was perfor-med. The first patient was a 62 years-old man with a 4-months history of frontal headache and short-termmemory defect with a single episode of generalizedseizure. Neurological examination was normal. BrainMRI with standard T1 and T2 sequences documented a2 cm right fronto-basal cavernoma. The second patientwas a 69 years-old woman with a 1-year history ofhyposmia and frontal headache. Neurological exami-nation showed a bilateral defect of the olfactory nerve.She underwent brain MRI with contrast medium whichdocumented a 4 cm olfactory grove midline meningio-ma. The third patient was a 49 years old man with an asymptomatic olfactory grove meningioma 3 cm large,diagnosed incidentally after a head injury. In all casessurgery was performed through a classical supraorbitalapproach with a limited keyhole craniotomy.Results and Conclusions. No intraoperative complica-tions were observed. The postoperative course wasuneventful. All patients were discharged from the ho-spital with no neurological deficits. Early postoperativebrain MRI scans confirmed the complete removal of thelesion in all cases. No eyebrow shaving, drainage place-ment or anticonvulsant medication were required.The minimally invasive supraorbital approach repre-sents an excellent alternative in the surgical treatmentof both intra- and extraxial lesions in the subfrontalregion. It provides a ready expeditious access to thebase of the anterior cranial fossa, minimizing brainretraction and avoiding large craniotomy or naso-orbi-tal osteotomies.Other advantages of such approach are the reductionof lenght of stay in hospital and the optimal cosmetic results.