Dr. Jho's Midline Anterior Skull Base Surgery via a Small Nose-Bridge Incision: Operation for Meningioma, Nasopharyngeal Carcinoma, Craniopharyngioma, Olfactory Neuroblastoma, other Skull Base Tumors: Minimally Invasive Skull Base Surgery Operation: Glabellar Approach
Hae Dong Jho, M.D., Ph.D.
Home: Dr. Jho's Innovative Minimally Invasive Neurosurgery for Spine and Brain Disorders
Link: JHO Institute for Minimally Invasive Neurosurgery
"Band-aid" brain surgery for midline skull base tumors such as meningiomas, nasopharyngeal carcinomas, craniopharyngiomas, olfactory neuroblastomas and other skull base tumors
"I hear and I forget. I see and I remember. I do and I understand." - Confucius
Facts About This Surgery
In order to minimize the size of skin and bone openings that are commonly used in conventional skull base (also called cranial base) procedures, a surgical approach has been developed that allows the surgeon a direct shortcut type of approach to tumors of the anterior skull base. Called the glabellar approach, it utilizes a one or two inch incision above the nose and between the eyes, the area known anatomically as the glabella. It is a modification of the frequently used frontal approach but does not incorporate the use of brain retractors which minimizes the potential for brain injury. Positive reports have been recieved concerning the cosmetic outcome of the incision as well. Great effort was taken to develop a "straight line to the problem" type of surgical approach that also focuses on preservation of surrounding anatomical structures. To utilize an analogy, this approach resembles the efforts of those who restore great works of art, bringing back the brilliance of the original work without disturbing the original content. Care is taken in the glabellar approach to accomplish tumor removal with minimal disruption of surrounding structures.
glabellar - referring to the anatomical region at the top of the nose between the eyes
MR scans, coronal views, reveal a large tumor (meningioma) preoperatively (left) and total resection of the tumor through a small skin incision at the nose-bridge postoperatively (right). The operation has been performed under an operating microscope or with an endoscope.
An excellent view of the optic chiasm, visualized microscopically, is seen during a glabellar skull base tumor resection.
Pictures demonstrate the line for the skin incision, postoperative bandage and the healed incision.
Top: Preoperative visual field testing results display significant visual field deficits portrayed by blackened areas. Bottom: After a glabellar approach and resection of an anterior skull base tumor, postoperative visual field results, on the same patient, display significant improvement in visual field defects.
Axial and sagittal views from a preoperative MRI disclose a large anterior fossa tumor in an elderly woman. The tumor was removed with an endoscope via a 2-cm-long nose bridge skin incision.
The corresponding postoperative axial and sagittal MRI views confirm complete tumor resection via a glabellar approach. The bright shadow in the sagittal MRI is an abdominal fat graft placed in the frontal and ethmoid sinus in order to prevent postoperative cerebrospinal fluid leakage.
Evolution of a Glabellar Incision
When an endoscope is utilized instead of the operating microscope a much smaller incision can be used. The photograph shows a postoperative bandage placed over a glabellar incision.
Incision as seen morning after surgery
Healed glabellar incision seen six weeks following surgery
Jho, HD and Ko, Y: Glabellar approach: a simplified midline anterior fossa skull base technique. Minimally Invasive Neurosurgery 40(2): 62-67, 1997
For referral information or appointment for consultation contact:
Manager: Robin A. Coret, B.S.- (412)359-6110 or e-mail at
Address: JHO Institute for Minimally Invasive Neurosurgery
7th Floor, Snyder Pavilion, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772
Contact Dr. Jho via email: DrJho@DrJho.com
Return to Home To Next Page