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Neurosurgery. 2009 May;64(5 Suppl 2):324-9; discussion 329-30. doi: 10.1227/01.NEU.0000338951.29171.07.

Transciliary orbitofrontozygomatic approach to lesions of the anterior cranial fossa.

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Auburn Neurosurgery, Auburn, Alabam, USA.



Several variations on the supraorbital craniotomy via a forehead or eyebrow incision have been described in the literature in recent years. A modification of this approach, the transciliary orbitofrontozygomatic approach, has been used by the authors as a minimally invasive method of approaching certain intracranial pathologies. The authors present their experience with this technique in 105 consecutive patients with tumors or aneurysms of the anterior cranial fossa.


A transciliary keyhole approach was used in all cases. From June 1998 to June 2005, 37 tumors, 1 cavernous malformation, and 77 anterior circulation aneurysms were treated (67 females, 38 males; age range, 8-77 years) with an orbitofrontozygomatic approach via an eyebrow incision. Patients were followed by the authors at a single institution for 1 year postoperatively.


Of the 105 patients treated with a transciliary orbitofrontozygomatic approach, 2 (1.9%) developed a cerebrospinal leak. Two other patients (1.9%) very early in the series had persistent forehead asymmetry at 1 year postoperatively. Two patients who underwent surgery for a ruptured aneurysm experienced an intraoperative rupture, which was thought to be unrelated to the exposure. None of the operations had to be converted to a pterional craniotomy.


This approach was used in 105 consecutive patients who underwent operation for either tumors or aneurysms via an eyebrow incision. The transciliary orbitofrontozygomatic approach is associated with low surgical morbidity. Although experience with this technique is still limited, it is a viable alternative in cases in which the pathology resides in the midline or anterior fossa.

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