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Minimally Invasive Transpalpebral Eyelid Approach to the Anterior Cranial Base

Abdel Aziz, Khaled M. MD, PhD*; Bhatia, Sanjay MD*; Tantawy, Mohammed Hammad MD*; Sekula, Raymond MD*; Keller, Jeffrey T. MD; Froelich, Sebastien MD§; Happ, Erik MD

doi: 10.1227/NEU.0b013e31821c3ea3
Operative Technique

BACKGROUND: Supra orbital frontal minicraniotomy is one of the most commonly used minimally invasive approaches for anterior cranial fossa lesions.

OBJECTIVE: To describe our experience with the transpalpebral “eyelid” incision to obtain access to the anterior cranial fossa.

METHODS: We describe the approach and technique of the transpalpebral eyelid incision in a step-by-step fashion and discuss the results of 40 cases for which the eyelid incision was used. We retrospectively reviewed the charts of these patients to analyze outcomes with regard to opening and closing time, length of hospital stay, residual aneurysm or Simpson grade for resection, complications, and cosmetic result.

RESULTS: We treated 31 anterior circulation aneurysms (28 unruptured and 3 ruptured), 7 anterior skull base meningiomas, 1 frontal low-grade glioma, and 1 frontal cavernoma using the transpalpebral incision. Opening time was about 45 to 60 minutes, and closure time from dura to skin was about 45 to 60 minutes. The hospital length of stay was similar to that in our open craniotomy cases. No residual aneurysm was demonstrated in the follow-up studies of all 31 aneurysms. Simpson grade I resection was achieved in 6 meningiomas. Complications included 1 postoperative eyelid hematoma, 2 postoperative infections, and a subclinical stroke discovered on postoperative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients.

CONCLUSION: The transpalpebral approach provides dissection in natural anatomical planes, affords preservation of the frontalis muscle, avoids injury to nerve VII branches, and results in an excellent cosmetic outcome.

Departments of *Neurosurgery and

Ophthalmology, Allegheny General Hospital, Drexel College of Medicine, Pittsburgh, Pennsylvania

Departments of Neurosurgery, University of Cincinnati College of Medicine and the Mayfield Clinic, Cincinnati, Ohio

§Department of Neurosurgery, University of Strasbourg, Strasbourg, France

Correspondence: Khaled M. Abdel Aziz, MD, PhD, Department of Neurosurgery, Allegheny General Hospital, Drexel College of Medicine, 420 East North Avenue, Suite 302, Pittsburgh, PA 15212. E-mail:

Received August 27, 2010

Accepted February 22, 2011

Copyright © by the Congress of Neurological Surgeons