Endoscope-assisted keyhole surgery via an eyebrow incision for removal of large meningiomas of the anterior and middle cranial fossa

• Key“burr”hole supraorbital approach for resection of giant skull base meningiomas.
• The supraorbital approach combined maximal exposure with minimal skin incision.
• With the supraorbital approach excellent cosmetic results are achieved.

BackgroundConventional open surgery of large meningiomas has proven to be challenging even in experienced hands. Intense retraction and dissection around neurovascular structures increase morbidity and mortality. In the present study, we retrospectively analyzed the surgical technique, and outcome in 40 patients with large anterior cranial fossa meningiomas extending to the middle fossa. All patients were approached via a supraorbital mini craniotomy.MethodsIt is a retrospective study of 40 patients (12 males, 28 females) who underwent surgery for large anterior cranial fossa meningiomas (diameter >5 cm) extending to the middle fossa in four different neurosurgical centers within 6 years. Depending on the localization of the tumor, the skin incision was between 2.5 and 3 cm long and was made without shaving the patient's eyebrow hair. Subsequently, a keyhole craniotomy was performed of approximately 0.8 × 1.2–1.4 cm in diameter. Preoperative and postoperative clinical and radiological data were analyzed and discussed.ResultsHeadache and psycho-organic syndrome were the most common presenting symptom in all patients. Presenting symptoms were associated with psychological changes in 23 cases, visual impairment in 19 patients, and anosmia in 17 patients. In overall, 36 of 40 patients (90%) showed a good outcome and returned at long-term follow-up to their previous occupations. The elderly patients returned to their daily routine.ConclusionWith the appropriate keyhole approach as a refinement of the classic keyhole craniotomy to a smaller key“burr”hole, and with use of modern and new designed equipment, it is possible to perform complete resection of large anterior and middle fossa meningiomas with the same safety, efficiency and with less complication rates as described in the literature for large meningiomas even performed with classic keyhole craniotomies.

(A–C) Preoperative and (D–F) postoperative MRI scans of a tuberculum sellae meningioma via a mini supraorbital craniotomy.Figure optionsDownload high-quality image (194 K)Download as PowerPoint slide