FRONTOLATERAL KEY HOLE CRANIOTOMY APPROACH TO ANTERIOR CRANIAL BASE

Abstract

Objective: To evaluate the Frontolateral key hole craniotomy as an alternative minimal invasive approach to anterior cranial base lesions.
Methods: Between September 2009 and september 2012 , 24 selected patient with anterior cranial base lesions, included ( 14 pituitary macroadenoma, 4 planum sphenoidal meningeoma, 2 tuberculum sellae meningeoma, 2 craniopharyngioma, 1 suprasellar germinoma, 1 ganglioneuroma ). Tumor size ranged from 15- 50 mm, with mean size 30.9±8.7mm. All patients underwent surgical intervention in the form of minimal invasive frontolateral keyhole craniotomy either supra-orbital; n= 12 patients or transsupra-orbital; n= 12 patients. The study included 13 males, and 11 females, age ranged between 8 -70 years (mean age 40.3ys). Follow up period ranged between 6 – 36 months. All patients underwent preoperative CT brain, and MRI brain . Postoperatively, all patients underwent CT and/or MRI brain. Results: 15 patients (62.5%) reported visual improvement after surgery, 8 patients (33.3%) reported no change in visual function and 1 patient (4.2%) died early postoperative. Gross total removal in 4 patients (16.7%); in 12 patients (50%) removal near total (more than 90%of the tumor); 7 patients ( 29.1%) removal was subtotal (from 70-90% of the tumor); and in one patient (4.2%) removal was partial (less than 70% of the tumor). Conclusion: Then Frontolateral key hole craniotomy is applicable minicraniotomy as an alternative minimal invasive approach to anterior cranial base lesions. It offers equal surgical possibilities with minimal brain retraction, allowing quick and minimally invasive access to the tumor with less brain exposure, and comparable results to standard approaches. In addition, the small skin incision, and small craniotomy result in a pleasing cosmetic outcome. Key words: Supraorbital Keyhole approach, eyebrow incision, minimally invasive skull base surgery, superciliary approach.