Resection of cranio-orbital communicating lesions through eyebrow incision

Objective Introducing a modified supraorbital keyhole approach with eyebrow incision and its surgical outcomes for cranio-orbital communicating lesions. Methods The clinical data of 21 cases from Mar 2005 to Jun 2007 were retrospectively studied. Patients ages ranged from 22 to 73 years with 48.8 years in average. Eight patients were male, 13 were female. The chief compliants were progressive proptosis and loss of visual acuity. Based on the relation of lesion and the optic nerve, lesions were classified into four types: internal, lateral, middle and mixed. We used suitable eyebrow incision so a one-piece supraorbital craniotomy was made that incorporated the orbital rim and roof and the frontal process of the zygomatic bone. The orbital osteotomy facilitated the view of the anterior and middle cranial fossa through the operating microscope. Duration of follow up was 1 month to 2 years. Results Total tumor removal was achieved in 14 cases, subtotal removal in 4 cases, partial removal in 1 case. Postoperatively, temporal CSF leak was found in 3 cases; ptosis was found in 8 cases but all recovered within 3 months. Frontal numbness occurred in 9 cases and persisted in 6 cases. There was no operative death or other significant complication. Tumor recurred in 1 case. Conclusions Adequate orbital apex decompression and exposure of the cranio-orbital communicating lesions can be achieve from suitable eyebrow incision. This approach is relatively safe and with few complications, and is minimal invasive. But supraorbital nerve injury in some patient is the drawback of this approach.