Cranio-orbital craniotomy via an eyebrow incision for resection of anterior clinoid and tuberculum sella meningiomas

Abstract

Abstract Background Anterior clinoid meningiomas (ACM) and tuberculum sella meningiomas (TSM) are anterior skull base tumors that commonly cause visual deterioration. The supraorbital keyhole approach may be used to resect these tumors but is limited by restricted intraoperative maneuverability. Objective To describe and demonstrate the safety and efficacy of our modified minimally invasive cranio-orbital craniotomy compared to traditional approaches. Methods All patients with an ACM or TSM treated with a modified cranio-orbital or traditional fronto-orbital (FO) craniotomy by the senior author were included. A literature review was conducted for ACMs and TSMs treated by transcranial (TC), endoscopic endonasal approach (EEA), and supraorbital keyhole (SoK) approaches. Visual outcomes, extent of resection, and complications were compared. Results Six patients who underwent modified cranio-orbital craniotomy and 4 patients who underwent FO were included. Amongst patients with preoperative visual deficits, 2/4 modified cranio-orbital patients experienced postoperative visual improvement, compared to 3/3 FO patients ( p = 0.43). Extent of resection was similar between groups. Complications related to superficial tissue dissection were less common in the modified cranio-orbital group ( p = 0.03). In the literature, EEA approaches were associated with higher rates of visual improvement compared to TC or SoK approaches, but EEA was associated with higher rates of postoperative CSF leak. Rate of visual improvement in our modified cranio-orbital patients were similar to those reported in the literature. Conclusion Our modified cranio-orbital craniotomy is a safe and effective approach that should be considered when planning for resection of ACMs and TSMs.