{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:13:22Z","timestamp":1790208802497,"version":"4.1.0"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The authors aimed to review the frontal lobe\u2019s surgical anatomy, describe their keyhole frontal lobectomy technique, and analyze the surgical results.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients with newly diagnosed frontal gliomas treated using a keyhole approach with supramaximal resection (SMR) from 2016 to 2022 were retrospectively reviewed. Surgeries were performed on patients asleep and awake. A human donor head was dissected to demonstrate the surgical anatomy. Kaplan-Meier curves were used for survival analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of the 790 craniotomies performed during the study period, those in 47 patients met our inclusion criteria. The minimally invasive approach involved four steps: 1) debulking the frontal pole; 2) subpial dissection identifying the sphenoid ridge, olfactory nerve, and optic nerve; 3) medial dissection to expose the falx cerebri and interhemispheric structures; and 4) posterior dissection guided by motor mapping, avoiding crossing the inferior plane defined by the corpus callosum. A fifth step could be added for nondominant lesions by resecting the inferior frontal gyrus. Perioperative complications were recorded in 5 cases (10.6%). The average hospital length of stay was 3.3 days. High-grade gliomas had a median progression-free survival of 14.8 months and overall survival of 23.9 months.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Keyhole approaches enabled successful SMR of frontal gliomas without added risks. Robust anatomical knowledge and meticulous surgical technique are paramount for obtaining successful resections.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.7.jns231363","type":"journal-article","created":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T01:43:14Z","timestamp":1696642994000},"page":"949-957","source":"Crossref","is-referenced-by-count":5,"title":["Minimally invasive keyhole approach for supramaximal frontal glioma resections: technical note"],"prefix":"10.3171","volume":"140","author":[{"given":"Mart\u00edn A.","family":"Merenzon","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mynor J.","family":"Mendez Valdez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Chandar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Marco del Pont","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis A.","family":"Morell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Eichberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lekhaj","family":"Daggubati","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina G.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish H.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"},{"name":"Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Ivan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"},{"name":"Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Komotar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami Hospital, Miami; and"},{"name":"Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Front Oncol","first-page":"574679","article-title":"Adult diffuse low-grade gliomas: 35-year experience at the Nancy France Neurooncology Unit","volume":"10","author":"Obara T","year":"2020","unstructured":"Obara T, Blonski M, Brzenczek C,  Adult diffuse low-grade gliomas: 35-year experience at the Nancy France Neurooncology Unit. Front Oncol. 2020;10:574679."},{"issue":"2","key":"b2","series-title":"J Neurooncol","first-page":"269","article-title":"Maximizing safe resection of low- and high-grade glioma","volume":"130","author":"Hervey-Jumper SL","year":"2016","unstructured":"Hervey-Jumper SL, Berger MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol. 2016;130(2):269\u2013282."},{"issue":"2","key":"b3","series-title":"J Neurosurg","first-page":"190","article-title":"A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival","volume":"95","author":"Lacroix M","year":"2001","unstructured":"Lacroix M, Abi-Said D, Fourney DR,  A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95(2):190\u2013198."},{"issue":"11","key":"b4","series-title":"J Clin Oncol","first-page":"2029","article-title":"Interactive effects of molecular, therapeutic, and patient factors on outcome of diffuse low-grade glioma","volume":"41","author":"Hervey-Jumper SL","year":"2023","unstructured":"Hervey-Jumper SL, Zhang Y, Phillips JJ,  Interactive effects of molecular, therapeutic, and patient factors on outcome of diffuse low-grade glioma. J Clin Oncol. 2023;41(11):2029\u20132042."},{"issue":"4","key":"b5","series-title":"JAMA Oncol","first-page":"495","article-title":"Association of maximal extent of resection of contrast-enhanced and non-contrast-enhanced tumor with survival within molecular subgroups of patients with newly diagnosed glioblastoma","volume":"6","author":"Molinaro AM","year":"2020","unstructured":"Molinaro AM, Hervey-Jumper S, Morshed RA,  Association of maximal extent of resection of contrast-enhanced and non-contrast-enhanced tumor with survival within molecular subgroups of patients with newly diagnosed glioblastoma. JAMA Oncol. 2020;6(4):495\u2013503."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"62","article-title":"Radical supramaximal resection for newly diagnosed left-sided eloquent glioblastoma: safety and improved survival over gross-total resection","volume":"138","author":"Di L","year":"2022","unstructured":"Di L, Shah AH, Mahavadi A,  Radical supramaximal resection for newly diagnosed left-sided eloquent glioblastoma: safety and improved survival over gross-total resection. J Neurosurg. 2022;138(1):62\u201369."},{"issue":"3","key":"b7","series-title":"J Neurooncol","first-page":"501","article-title":"Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection","volume":"148","author":"Shah AH","year":"2020","unstructured":"Shah AH, Mahavadi A, Di L,  Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection. J Neurooncol. 2020;148(3):501\u2013508."},{"issue":"1","key":"b8","series-title":"Asian J Neurosurg","first-page":"14","article-title":"Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach","volume":"9","author":"Mori K","year":"2014","unstructured":"Mori K. Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach. Asian J Neurosurg. 2014;9(1):14\u201320."},{"issue":"4","key":"b9","series-title":"Neurosurg Rev","first-page":"2983","article-title":"Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions","volume":"45","author":"Paolini S","year":"2022","unstructured":"Paolini S, Severino R, Mancarella C,  Mini-craniotomy for intra-axial brain tumors: a comparison with conventional craniotomy in 306 patients harboring non-dural based lesions. Neurosurg Rev. 2022;45(4):2983\u20132991."},{"issue":"4 suppl","key":"b10","series-title":"Neurosurgery","first-page":"242","article-title":"Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision","volume":"57","author":"Reisch R","year":"2005","unstructured":"Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery. 2005;57(4 suppl):242\u2013255."},{"issue":"4","key":"b11","series-title":"Neurosurg Focus","first-page":"E20","article-title":"Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxial and intraaxial tumors","volume":"37","author":"Gazzeri R","year":"2014","unstructured":"Gazzeri R, Nishiyama Y, Teo C. Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxial and intraaxial tumors. Neurosurg Focus. 2014;37(4):E20."},{"key":"b12","series-title":"J Clin Neurosci","first-page":"57","article-title":"Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: a safety and feasibility study","volume":"72","author":"Figueroa J","year":"2020","unstructured":"Figueroa J, Morell A, Bowory V,  Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: a safety and feasibility study. J Clin Neurosci. 2020;72:57\u201362."},{"issue":"3","key":"b13","series-title":"Neurosurgery","first-page":"388","article-title":"Frontal keyhole craniotomy for resection of low- and high-grade gliomas","volume":"82","author":"Burks JD","year":"2018","unstructured":"Burks JD, Conner AK, Bonney PA,  Frontal keyhole craniotomy for resection of low- and high-grade gliomas. Neurosurgery. 2018;82(3):388\u2013396."},{"key":"b14","series-title":"World Neurosurg","first-page":"347","article-title":"Frontal lobe decortication (frontal lobectomy with ventricular preservation) in epilepsy\u2013part 1: anatomic landmarks and surgical technique","volume":"98","author":"Wen HT","year":"2017","unstructured":"Wen HT, Da R\u00f3z LM, Rhoton AL Jr, Castro LHM, Teixeira MJ. Frontal lobe decortication (frontal lobectomy with ventricular preservation) in epilepsy\u2013part 1: anatomic landmarks and surgical technique. World Neurosurg. 2017;98:347\u2013364."},{"issue":"2","key":"b15","series-title":"Neurosurg Focus","first-page":"E2","article-title":"The cerebral sulci and gyri","volume":"28","author":"Ribas GC","year":"2010","unstructured":"Ribas GC. The cerebral sulci and gyri. Neurosurg Focus. 2010;28(2):E2."},{"issue":"suppl 1","key":"b16","series-title":"Oper Neurosurg (Hagerstown)","first-page":"S1","article-title":"A connectomic atlas of the human cerebrum\u2014Chapter 1: Introduction, methods, and significance","volume":"15","author":"Baker CM","year":"2018","unstructured":"Baker CM, Burks JD, Briggs RG,  A connectomic atlas of the human cerebrum\u2014Chapter 1: Introduction, methods, and significance. Oper Neurosurg (Hagerstown). 2018;15(suppl 1):S1\u2013S9."},{"issue":"3","key":"b17","series-title":"J Neurosurg Anesthesiol","first-page":"240","article-title":"Awake craniotomy for brain tumor resection: the rule rather than the exception?","volume":"25","author":"Brown T","year":"2013","unstructured":"Brown T, Shah AH, Bregy A,  Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol. 2013;25(3):240\u2013247."},{"key":"b18","series-title":"Clin Neurol Neurosurg","first-page":"107015","article-title":"Ventricle wall resection contributes to supramaximal resection and prognosis in SVZ-involved frontal gliomas: a single center retrospective study","volume":"211","author":"Que T","year":"2021","unstructured":"Que T, Zheng H, Tan JE,  Ventricle wall resection contributes to supramaximal resection and prognosis in SVZ-involved frontal gliomas: a single center retrospective study. Clin Neurol Neurosurg. 2021;211:107015."},{"issue":"21","key":"b19","series-title":"J Clin Oncol","first-page":"2439","article-title":"Response Assessment in Neuro-Oncology clinical trials","volume":"35","author":"Wen PY","year":"2017","unstructured":"Wen PY, Chang SM, Van den Bent MJ, Vogelbaum MA, Macdonald DR, Lee EQ. Response Assessment in Neuro-Oncology clinical trials. J Clin Oncol. 2017;35(21):2439\u20132449."},{"issue":"2","key":"b20","series-title":"J Neurooncol","first-page":"345","article-title":"Same-day discharge after brain tumor resection: a prospective pilot study","volume":"157","author":"Vallejo FA","year":"2022","unstructured":"Vallejo FA, Eichberg DG, Morell AA,  Same-day discharge after brain tumor resection: a prospective pilot study. J Neurooncol. 2022;157(2):345\u2013353."},{"issue":"2","key":"b21","series-title":"World Neurosurg","first-page":"505","article-title":"Early discharge after surgery for intra-axial brain tumors","volume":"84","author":"Sughrue ME","year":"2015","unstructured":"Sughrue ME, Bonney PA, Choi L, Teo C. Early discharge after surgery for intra-axial brain tumors. World Neurosurg. 2015;84(2):505\u2013510."},{"issue":"4","key":"b22","series-title":"J Neurosurg","first-page":"977","article-title":"The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection?","volume":"124","author":"Li YM","year":"2016","unstructured":"Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg. 2016;124(4):977\u2013988."},{"issue":"5","key":"b23","series-title":"Neuro Oncol","first-page":"812","article-title":"Association of supratotal resection with progression-free survival, malignant transformation, and overall survival in lower-grade gliomas","volume":"23","author":"Rossi M","year":"2021","unstructured":"Rossi M, Gay L, Ambrogi F,  Association of supratotal resection with progression-free survival, malignant transformation, and overall survival in lower-grade gliomas. Neuro Oncol. 2021;23(5):812\u2013826."},{"issue":"6","key":"b24","series-title":"Cancers (Basel)","first-page":"1772","article-title":"A systematic review and meta-analysis of supramarginal resection versus gross total resection in glioblastoma: can we enhance progression-free survival time and preserve postoperative safety?","volume":"15","author":"Wach J","year":"2023","unstructured":"Wach J, Vychopen M, K\u00fchnapfel A, Seidel C, G\u00fcresir E. A systematic review and meta-analysis of supramarginal resection versus gross total resection in glioblastoma: can we enhance progression-free survival time and preserve postoperative safety? Cancers (Basel). 2023;15(6):1772."},{"key":"b25","series-title":"World Neurosurg","first-page":"e747","article-title":"An examination of the role of supramaximal resection of temporal lobe glioblastoma multiforme","volume":"114","author":"Glenn CA","year":"2018","unstructured":"Glenn CA, Baker CM, Conner AK,  An examination of the role of supramaximal resection of temporal lobe glioblastoma multiforme. World Neurosurg. 2018;114:e747\u2013e755."},{"issue":"1","key":"b26","series-title":"J Neurooncol","first-page":"129","article-title":"Maximize surgical resection beyond contrast-enhancing boundaries in newly diagnosed glioblastoma multiforme: is it useful and safe? A single institution retrospective experience","volume":"135","author":"Pessina F","year":"2017","unstructured":"Pessina F, Navarria P, Cozzi L,  Maximize surgical resection beyond contrast-enhancing boundaries in newly diagnosed glioblastoma multiforme: is it useful and safe? A single institution retrospective experience. J Neurooncol. 2017;135(1):129\u2013139."},{"issue":"5","key":"b27","series-title":"Br J Neurosurg","first-page":"528","article-title":"Extending the resection beyond the contrast-enhancement for glioblastoma: feasibility, efficacy, and outcomes","volume":"32","author":"Mampre D","year":"2018","unstructured":"Mampre D, Ehresman J, Pinilla-Monsalve G,  Extending the resection beyond the contrast-enhancement for glioblastoma: feasibility, efficacy, and outcomes. Br J Neurosurg. 2018;32(5):528\u2013535."},{"issue":"3","key":"b28","series-title":"J Neurooncol","first-page":"455","article-title":"Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates","volume":"149","author":"Schneider M","year":"2020","unstructured":"Schneider M, Ilic I, Potthoff AL,  Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates. J Neurooncol. 2020;149(3):455\u2013461."},{"issue":"5","key":"b29","series-title":"Cancers (Basel)","first-page":"1116","article-title":"The frontal aslant tract and supplementary motor area syndrome: moving towards a connectomic initiation axis","volume":"13","author":"Briggs RG","year":"2021","unstructured":"Briggs RG, Allan PG, Poologaindran A,  The frontal aslant tract and supplementary motor area syndrome: moving towards a connectomic initiation axis. Cancers (Basel). 2021;13(5):1116."},{"issue":"3","key":"b30","series-title":"Brain Behav","first-page":"e00926","article-title":"The crossed frontal aslant tract: a possible pathway involved in the recovery of supplementary motor area syndrome","volume":"8","author":"Baker CM","year":"2018","unstructured":"Baker CM, Burks JD, Briggs RG,  The crossed frontal aslant tract: a possible pathway involved in the recovery of supplementary motor area syndrome. Brain Behav. 2018;8(3):e00926."},{"issue":"6 suppl","key":"b31","series-title":"World Neurosurg","first-page":"S72","article-title":"The supraorbital endoscopic approach for tumors","volume":"82","author":"Wilson DA","year":"2014","unstructured":"Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg. 2014;82(6 suppl):S72\u2013S80."},{"issue":"3","key":"b32","series-title":"Brain Sci","first-page":"498","article-title":"Standardization of strategies to perform a parafascicular tubular approach for the resection of brain tumors in eloquent areas","volume":"13","author":"Abdala-Vargas NJ","year":"2023","unstructured":"Abdala-Vargas NJ, Umana GE, Pati\u00f1o-Gomez JG,  Standardization of strategies to perform a parafascicular tubular approach for the resection of brain tumors in eloquent areas. Brain Sci. 2023;13(3):498."},{"issue":"4 suppl 2","key":"b33","series-title":"Neurosurgery","first-page":"334","article-title":"Stereotactic minimally invasive tubular retractor system for deep brain lesions","volume":"63","author":"Greenfield JP","year":"2008","unstructured":"Greenfield JP, Cobb WS, Tsouris AJ, Schwartz TH. Stereotactic minimally invasive tubular retractor system for deep brain lesions. Neurosurgery. 2008;63(4 suppl 2):334\u2013340."},{"issue":"1","key":"b34","series-title":"J Neurosurg","first-page":"7","article-title":"Risk factor analysis of the development of new neurological deficits following supplementary motor area resection","volume":"119","author":"Kim YH","year":"2013","unstructured":"Kim YH, Kim CH, Kim JS,  Risk factor analysis of the development of new neurological deficits following supplementary motor area resection. J Neurosurg. 2013;119(1):7-14."},{"key":"b35","series-title":"Front Neurol","first-page":"711646","article-title":"Reducing the cognitive footprint of brain tumor surgery","volume":"12","author":"Dadario NB","year":"2021","unstructured":"Dadario NB, Brahimaj B, Yeung J, Sughrue ME. Reducing the cognitive footprint of brain tumor surgery. Front Neurol. 2021;12:711646."},{"issue":"4","key":"b36","series-title":"J Pers Med","first-page":"587","article-title":"Should neurosurgeons try to preserve non-traditional brain networks? A systematic review of the neuroscientific evidence","volume":"12","author":"Dadario NB","year":"2022","unstructured":"Dadario NB, Sughrue ME. Should neurosurgeons try to preserve non-traditional brain networks? A systematic review of the neuroscientific evidence. J Pers Med. 2022;12(4):587."},{"issue":"1","key":"b37","series-title":"Neurooncol Adv","first-page":"vdac142","article-title":"Using machine learning to evaluate large-scale brain networks in patients with brain tumors: traditional and non-traditional eloquent areas","volume":"4","author":"Morell AA","year":"2022","unstructured":"Morell AA, Eichberg DG, Shah AH,  Using machine learning to evaluate large-scale brain networks in patients with brain tumors: traditional and non-traditional eloquent areas. Neurooncol Adv. 2022;4(1):vdac142."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p949.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p949.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/140\/4\/article-p949.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T10:19:42Z","timestamp":1716632382000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/140\/4\/article-p949.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":37,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.7.jns231363","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}