A superciliary approach for anterior cranial fossa lesions in children

Technical note

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✓Many subfrontal and orbitofrontal craniotomy techniques have been proposed and developed for anterior cranial fossa lesions. The purpose of this study was to evaluate the surgical experience with the frontolateral keyhole craniotomy through a superciliary skin incision in children.

The keyhole craniotomy is a modification of the traditional pterional approach. This modified approach, a craniotomy with a 2.5 × 3—cm bone opening just above the eyebrow through a superciliary incision, has been previously described in adults for many lesions situated in the anterior cranial fossa, including tumors and aneurysms. The authors review their experience in using this approach in 27 children for a variety of intracranial lesions.

This approach was used for 28 procedures in children ranging in age from 1 to 16 years (mean age 10 years). The lesions included arachnoid cysts, cerebrospinal fluid fistulas, and tumors; no vascular lesions were treated.

The authors have found this craniotomy to be a safe and simple approach for treating anterior cranial fossa and suprasellar lesions in children.

Article Information

Address reprint requests to: George Jallo, M.D., Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 811, Baltimore, Maryland 21287. email: gjallo1@jhmi.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Illustrations of the superciliary approach and frontolateral craniotomy. Left: Operative positioning for children. Center: An illustration of the planned skin incision and keyhole craniotomy. Right: Exposure provided by this craniotomy. The skin retractors provide adequate exposure to the frontal base. Br = branch; m = muscle; med = medial; n = nerve.

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    Magnetic resonance imaging studies obtained in a 15-year-old boy who presented with visual loss. A: Coronal T1-weighted image demonstrating the cystic tumor with elevation of the optic chiasm. B: Coronal T2-weighted image demonstrating signal intensity similar to CSF and deviation of the optic nerve and chiasm. C: Axial Gd-enhanced T1-weighted image demonstrating the eccentric location of the tumor with minimal enhancement.

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    A CT scan demonstrating the cystic suprasellar tumor. There is minimal calcification at the most superior aspect of this tumor.

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    Intraoperative photographs of the steps involved for this minimally invasive approach. A: Exposure of the bone flap following the superciliary skin incision and prior to creating the burr hole. The retractors provide adequate retraction of the skin edges. The zygomatic process is visualized. B: The craniotomy flap is removed using one small burr hole underneath the temporal muscle and drilling of the orbital roof to minimize retraction of the brain. C: Closure of the bone flap with resorbable plates.

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    Postoperative MR images. A: Coronal T1-weighted image demonstrating the extent of tumor resection and preservation of the optic chiasm. B: Axial T1-weighted image further demonstrating the tumor resection.

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    Postoperative photographs of a patient 12 weeks after surgery. The incision is barely visible after a right supraciliary approach for tumor removal.

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