Supraorbital Approach to Anterior Skull Base and Intraorbital Lesions

To get effective access to the floor of the frontal fossa and the superior orbit, the resection of supraorbital rim has been done. We performed the supraorbital approach as combined technique with uni- or bifrontal craniotomy in order to minimize frontal lobe retraction and achieve excellent exposure for safe manipulation in seven patients of anterior skull base and intraorbital lesions. Of seven patients, two patients of olfactory groove meningioma underwent the operation with supraorbital bifrontal craniotomy;one patient of tuberculum sellar meningioma, bifrontal supraorbital-pterional approach;four patients of intraorbital benign lesions(one patient of meningioma, one patient of neurilemmoma, two patients of benign lesions in lacrimal gland), supraorbital unifrontal craniotomy. There was little or no functional, anatomical, or cosmetic deficit associated with this approach technique. We believe the supraorbital approach to be a helpful technique as combined procedure of the uni- or bifrontal approach and the approach of choice for the intraorbital tumors except those in the inferior portion.

An Extended Frontal Approach to Midline Lesions of the Anterior Skull Base

Relatively huge lesions in the parasellar and midline anterior skull base region are difficult to approach for radical procedures. To minimize brain retraction and achieve excellent exposure for safe manipulation within these regions, the authors have performed an extended frontal approach, a fibrontal craniotomy and a bilateral orbitofrontal osteotomy in 11 patients, and an additional transfacial maxillotomy in 1 patient. An additional removal of the orbital rim offers excellent visualization and permits unhindered surgical manipulation including postoperative reconstruction at the anterior skull base. But disadvantages include prolonged operative time and frequent ilateral olfactory denervation. Six patients with benign tumors, two patients with malignant tumors, one patient with hematoma in the ehtmoid and sphenoid sinuses, and three patients with delayed traumatic CSF rhinorheas were operated on using this approaches, with good results. The operative technique and its results are detailed.