Dr. Jho's Eyebrow Incision Skull Base Surgery: Operation for Meningioma, Craniopharyngioma, Parasellar Tumor, Cerebral Aneurysm: Orbital Roof Craniotomy: Minimally Invasive Skull Base Surgery for Brain Tumors

Hae Dong Jho, M.D., Ph.D.

"Band-aid" Brain surgery for meningiomas, craniopharyngiomas, parasellar tumors and cerebral aneurysms

Facts About This Surgery

• Is an alternative approach to skull base tumors that provides vital exposure for the surgeon and provides acceptable cosmetic effects for patients
• Is minimally invasive because it utilizes less bone removal and smaller skin incisions than conventional procedures
• Is innovative because it does away with the need for brain retractors which reduces the chance of injury to the brain
• Can be utilized for brain tumor removal and for cerebral aneurysm clipping

Discussion

This minimally invasive approach to the skull base provides the surgeon with exposure to the anterior fossa and parasellar region. Anatomically, that is the front portion of the skull base behind the nose and eyes and includes the area around the pituitary gland. It is done through a hole in the skull about an inch long and utilizes a skin incision above the eyebrow that is about two inches long. Positive patient input has been received concerning cosmetic outcome of the incisions. Not only does this procedure provide acceptable cosmetic outcome, it provides effective and direct exposure for tumor removal as well as for clipping of cerebral aneurysms. When coal miners first dug tunnels they had to ensure that they were wide enough to permit swinging of picks and shovels. What they had to do was create a tunnel small enough so as not to weaken the ground above, but large enough to permit work to take place. In comparison, this surgery, by utilizing the natural anatomical spaces and cavities of the brain, provides the surgeon with an ample working space that does not endanger the surrounding structures. Neither outcome or exposure is sacrificed in providing patients with alternative surgical techniques that approach a surgically challenging anatomical area.

Definitions

craniotomy - an operation producing an opening in the cranium

Images

          

MR scans, sagittal view, show a large tumor (teratoma) beneath the brain preoperatively (left) and its total resection postoperatively (right).

          

A picture depicts a line drawn for the skin incision in the operating room and the healed incisional line postoperatively.

          

Axial view (left) and a sagittal view (right) of a preoperative MRI scan display a large craniopharyngioma in the third ventricle.

              

Corresponding postoperative MRI views confirm complete tumor resection (left and center). (Right) A patient following an orbital craniotomy with an eyebrow incision.

              

Preoperative MRI scans show a meningioma (left), severe surrounding brain edema (center), and 2 photographs of a postoperative patient show a covered eyebrow incision in recovery room (right), and a healed incision at 6 weeks after surgery (inset).

          

Postoperative MRI images, sagittal (left) and axial (right) confirm complete tumor resection.

          

A preoperative MRI showing a craniopharyngioma (left), and a postoperative MRI displays complete resection of tumor via orbital roof craniectomy (right).

          

A magnified operative photograph provides a clear image of the optic nerve with tumor adhered (left) and the same optic nerve with tumor removed during an orbital roof craniotomy in a patient with a tuberculum sellar meningioma.

Reference

Jho, HD: Orbital roof craniotomy: Simplified anterior skull base approach. Minimally Invasive Neurosurgery 40(3): 91-97, 1997