Supraorbital Eyebrow Craniotomy for Removal of Intraaxial Frontal Brain Tumors: A Technical Note

OBJECTIVE: To present the utility and selection criteria for the supraorbital (SO) craniotomy, an approach commonly used to remove extraaxial tumors such as meningiomas and craniopharyngiomas, to resect intraaxial frontal brain lesions. METHODS: All consecutive patients who underwent a SO craniotomy for an intraaxial lesion were retrospectively analyzed for lesion location, pathology, extent of resection, operative times, length of stay, and complications. RESULTS: During 28 months, 10 patients (mean age, 67.6 years; 7 women) underwent 11 SO procedures to resect intraaxial brain lesions. Pathologies included metastatic carcinoma (n = 7), glioma (n = 2), and radiation necrosis (n = 1). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near-total removal was achieved in 80% of the cases. Median length of hospital stay was 3 days (range, 2-6 days); it was 2 days for patients admitted electively for SO craniotomy. There were no new neurologic deficits, postoperative hematomas, or cerebrospinal fluid leaks. CONCLUSIONS: The SO "eyebrow" craniotomy is a safe and effective keyhole method to remove intraaxial frontal lobe lesions, particularly lesions of the frontal pole and orbitofrontal region, allowing for minimal disruption of normal brain parenchyma and promoting a rapid recovery and short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intraaxial tumors can also be effectively accessed via this route with excellent clinical outcomes.