Extended Supraorbital Approach

The extended supraorbital approach through a modified eyebrow skin incision is a minimally invasive variant of the frontotemporal or pterional approaches that enrich a neurosurgeon's armamentarium for the treatment of pathologies lateral to the anterior clinoid process, by advancing laterally with frontal facial nerve branches monitoring. In order to demonstrate the steps of the approach, the authors studied two formalin-fixed and artery/vein silicone-injected adult cadaveric heads, and reviewed one of the three clinical cases operated upon to illustrate the applicability of the approach.

A 56-year-old woman presented with a history of seizures and a complaint of headache that started 2 months ago. She underwent an examination with brain magnetic resonance imaging (MRI) that showed a dural-based lesion at the medial third of the lesser wing of sphenoid (which is consistent with meningioma). The patient underwent craniotomy with an extended supraorbital approach through a modified eyebrow incision that allowed the Simpson II removal to be performed and good aesthetic outcome to be achieved.

The extended supraorbital approach through a modified eyebrow incision is a minimally invasive approach that can add to a neurosurgeon's armamentarium and it can be used with microscopy, assisted by endoscope, or both to reach the anterior and middle cranial fossae ¹⁾.