{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:16:54Z","timestamp":1792459014464,"version":"4.5.0"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Keyhole neurosurgery is the notion of safely removing brain and skull base lesions through smaller and more precise openings that lessen collateral damage to the surrounding scalp, brain, blood vessels, and nerves. The traditional frontal and pterional approaches require large craniotomies and this predisposes patients to significant and avoidable morbidity. With the growing expectation for minimally invasive surgery, we present our experience with the supraorbital keyhole craniotomy for surgical lesions in the anterior cranial fossa and parasellar regions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>We retrospectively analyzed and evaluated all cases of neoplastic, vascular, trauma, and infective pathologies of the anterior fossa and parasellar regions treated using a keyhole approach, the supraorbital eyebrow (SOE) approach from January 2018 to June 2022. Treatment outcomes were evaluated based on pathology.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>A total of 50 patients underwent a SOE craniotomy during the study period (28 females and 22 males). Their average age ranged from 12 to 86 years, with a mean age of 47.4 years. All patients had anterior skull base and\/or anterior frontal lobe pathologies: (23 tumors, 17 ruptured aneurysms, five traumatic frontal hematomas, three extradural empyema, one cerebral cavernous malformation, and one traumatic frontal skull base fracture with dural tear and CSF leak). Gross total tumor resection was achieved in 87% of cases (13 meningiomas of which six were giant, three gliomas, two craniopharyngiomas, and two cerebral metastases). Clip ligation occlusion rate for our aneurysm cases was 100% and intraoperative rerupture was observed in three cases. Mean ICU stay was 2.2 days for the entire series. The overall 30-day mortality rate for our series was 16% (eight deaths). This was highest in the ruptured aneurysm subgroup, with all 5 mortality cases in the aneurysmal subgroup presenting as World Federation of Neurological Surgeons (WFNS) grades \u2265 III. 4 of the deaths were in WFNS IV and V patients. The most frequent perioperative complication was transient periorbital swelling which resolved within 7 days. It was observed in 18 of the 50 patients. The next common complications in descending frequency were eyebrow alopecia (three cases), supraorbital hypoesthesia (two cases), CSF leak (two cases), and surgical site infection (one case). There was one approach-related intraoperative complication secondary to carotid injury in a giant meningioma redo case. Conversion to a larger craniotomy was never necessary. Clinical outcome for our cases was evaluated according to the Modified Rankin Scale (mRS) at 3-month postsurgery. A good clinical outcome (mRS \u2264 2) was achieved for 78% of our patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>The SOE approach craniotomy is an effective minimally invasive approach for various pathologies of the anterior cranial base and parasellar regions. With experience, giant tumors and complex vascular pathology can be addressed with this keyhole approach.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_810_2022","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T09:05:42Z","timestamp":1669971942000},"page":"566","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Supraorbital eyebrow approach: A single-center experience"],"prefix":"10.25259","volume":"13","author":[{"given":"Blessing","family":"Ndlovu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of the Witwatersrand, Medical School, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ouwais Abdul","family":"Sattar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helen Joseph Hospital, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mlamuli Mzamo","family":"Mkhaliphi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helen Joseph Hospital, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keletso","family":"Leola","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of the Witwatersrand, Medical School, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morena Nthuse","family":"Mpanza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helen Joseph Hospital, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Richard","family":"Ouma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of the Witwatersrand, Medical School, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Profyris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Helen Joseph Hospital, Johannesburg, South Africa."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"10.25259\/SNI_810_2022\/ref-1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/S0090-3019(02)00698-5","article-title":"Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions","volume":"57","author":"Czirj\u00e1k","year":"2002","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_810_2022\/ref-2","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/2152-7806.159489","article-title":"Large and giant skull base meningiomas: The role of radical surgical removal","volume":"29;6","author":"Da Silva","year":"2015","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_810_2022\/ref-3","doi-asserted-by":"crossref","first-page":"5555","DOI":"10.1038\/s41598-021-85115-7","article-title":"Comparative study between minimally invasive supraorbital craniotomy and pterional craniotomy for treating anterior circulation cerebral aneurysms in a low-resource setting","volume":"11","author":"Fonseca","year":"2021","journal-title":"Sci Rep"},{"key":"10.25259\/SNI_810_2022\/ref-4","doi-asserted-by":"crossref","first-page":"E20","DOI":"10.3171\/2014.7.FOCUS14203","article-title":"Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxial and intraaxial tumors","volume":"37","author":"Gazzeri","year":"2014","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI_810_2022\/ref-5","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s12883-021-02229-1","article-title":"Time course of outcome in poor grade subarachnoid hemorrhage patients: A longitudinal retrospective study","volume":"21","author":"Gouv\u00eaa Bogossian","year":"2021","journal-title":"BMC Neurol"},{"key":"10.25259\/SNI_810_2022\/ref-6","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1159\/000524537","article-title":"The eyebrow approach for the management of pediatric frontal epidural abscesses secondary to diffuse sinusitis","volume":"57","author":"Hallak","year":"2022","journal-title":"Pediatr Neurosurg"},{"key":"10.25259\/SNI_810_2022\/ref-7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.2176\/nmc.oa.2015-0242","article-title":"Minimally invasive supraorbital keyhole approach for the treatment of anterior cranial fossa meningiomas","volume":"56","author":"Iacoangeli","year":"2016","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_810_2022\/ref-8","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1097\/00029330-200608020-00002","article-title":"Clinical application of keyhole techniques in minimally invasive neurosurgery","volume":"119","author":"Lan","year":"2006","journal-title":"Chin Med J (Engl)"},{"key":"10.25259\/SNI_810_2022\/ref-9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10143-019-01188-z","article-title":"International expert consensus statement about methods and indications for keyhole microneurosurgery from international society on minimally invasive neurosurgery","volume":"44","author":"Lan","year":"2021","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_810_2022\/ref-10","first-page":"99","article-title":"Factors influencing morbidity and mortality after cranial meningioma surgery-a multivariate analysis","volume":"65","author":"Meixensberger","year":"1996","journal-title":"Acta Neurochir Suppl"},{"key":"10.25259\/SNI_810_2022\/ref-11","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1016\/j.wneu.2017.09.184","article-title":"Surgical management of giant intracranial meningioma: Operative nuances, challenges, and outcome","volume":"110","author":"Narayan","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_810_2022\/ref-12","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/FOC\/2008\/24\/6\/E11","article-title":"Supraciliary keyhole craniotomy for brain abscess debridement","volume":"24","author":"Noggle","year":"2008","journal-title":"Neurosurg Focus"},{"key":"10.25259\/SNI_810_2022\/ref-13","doi-asserted-by":"crossref","first-page":"846","DOI":"10.3340\/jkns.2021.0248","article-title":"Supraorbital endoscopic evacuation for traumatic intracerebral hematomas in the frontal lobe","volume":"65","author":"Oh","year":"2022","journal-title":"J Korean Neurosurg Soc"},{"key":"10.25259\/SNI_810_2022\/ref-14","first-page":"296469","article-title":"The supraorbital keyhole craniotomy through an eyebrow incision: Its origins and evolution","volume":"2013","author":"Ormond","year":"2013","journal-title":"Mini Invasive Surg"},{"key":"10.25259\/SNI_810_2022\/ref-15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.20408\/jti.2019.002","article-title":"Comparison of the surgical approaches for frontal traumatic intracerebral hemorrhage","volume":"32","author":"Park","year":"2019","journal-title":"J Trauma Injury"},{"key":"10.25259\/SNI_810_2022\/ref-16","article-title":"Keyhole Concept in Neurosurgery","year":"1999"},{"key":"10.25259\/SNI_810_2022\/ref-17","first-page":"242","article-title":"Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision","volume":"57","author":"Reisch","year":"2005","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_810_2022\/ref-18","doi-asserted-by":"crossref","first-page":"458","DOI":"10.25259\/SNI_767_2020","article-title":"Single surgeon experience with minimally invasive supraorbital craniotomy versus bifrontal craniotomy for anterior skull base meningiomas","volume":"11","author":"Seaman","year":"2020","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_810_2022\/ref-19","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/S0090-3019(96)00539-3","article-title":"The supraorbital keyhole approach to supratentorial aneurysms: Concept and technique","volume":"49","author":"Van Lindert","year":"1998","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_810_2022\/ref-20","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1055\/s-2004-818526","article-title":"The supraorbital keyhole approach via an eyebrow incision for resection of tumors around the sella and the anterior skull base","volume":"47","author":"Wiedemayer","year":"2004","journal-title":"Mini Invasive Neurosurg"},{"key":"10.25259\/SNI_810_2022\/ref-21","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1016\/j.wneu.2013.02.002","article-title":"The supraorbital endoscopic approach for tumors","volume":"82","author":"Wilson","year":"2014","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_810_2022\/ref-22","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/SCS.0000000000008071","article-title":"The supraorbital approach via an eyebrow incision: Analysis of cosmetic outcomes using the scar cosmesis assessment rating scale","volume":"33","author":"Ziai","year":"2022","journal-title":"J Craniofac Surg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/supraorbital-eyebrow-approach-a-single-center-experience\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/supraorbital-eyebrow-approach-a-single-center-experience\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T09:05:55Z","timestamp":1669971955000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/supraorbital-eyebrow-approach-a-single-center-experience\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,2]]},"references-count":22,"alternative-id":["10.25259\/SNI_810_2022"],"URL":"https:\/\/doi.org\/10.25259\/sni_810_2022","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,2]]},"article-number":"566"}}