Eyebrow approach procedures for upper eyelid rejuvenation / 中华医学美学美容杂志

Objective To explore the clinical indication and operative methods for different upper eyelid aging through perieyebrow incision.Methods We collected totally one hundred fifty-two cases in this study,including six males and 146 females,and aged from 26 to 80 years (average 47).There were 29 cases with only ptosis of upper eyelid,and the rest 123 cases were ptosis of upper eyelid with ptosis of eyebrow,sunken upper eyelid,bloated upper eyelid,or over-wide between eyebrow and eye region (compensatory eyebrow elevation).Through the incision of upper or lower margin of eyebrow,we treated these five types of upper eyelid aging by excision of redundant skin,orbicularis oculi muscle,frontal muscle,ROOF,or orbital fat,or ROOF elevation for upper eyelid rejuvenation.Results Patients were followed up for 3 to 120 months,with average 14.4 months.All ptosis of upper eyelid and over-wide between eyebrow and eye region patients were improved obviously.In 36 ptosis of upper eyelid with ptosis of eyebrow,seven of them treated with upper eyebrow margin incision got the best results;and the rest 29 patients treated with lower eyebrow margin incision,fifteen patients were lifted slightly,and the rest fourteen patients got no improvement.All scars of inferior eyebrow margin incision were invisible.Faded and applanate one millimeter wide scars were seen on two patients with superior eyebrow margin incision.In all patients with ptosis of upper eyelid,80％ patients with sunken upper eyelid were improved obviously,and 85 ％ with bloated upper eyelid were improved significantly.Conclusions Upper eyelid aging is divided into five categories.Upper eyelid aging could be corrected by perieyebrow approach.Our methods are simple,safe,fewer complications,and with short convalescence,which is the minimally invasive procedure recommended for Chinese patients with upper eyelid aging.

Early Aneurysm Surgery using Eyebrow Incision for Poor Grade Patients

OBJECTIVE: This study is aimed to assess the clinical outcome in early and minimally invasive surgery using an eyebrow incision for the patients with poor grade aneurysm. METHODS: The authors retrospectively reviewed all 46 poor grade patients of Hunt and Hess(H-H) grade IV and V who suffered aneurysmal subarachnoid hemorrhage(SAH) between 1999 and 2004. All 35 patients harboring 43 aneurysms who underwent early surgery within 72 hours were included in this study. Clinical outcome was assessed by Glasgow outcome scale(GOS) and compared with that of conventional pterional approach. RESULTS: Twenty four patients were operated with conventional pterional approach and 11 with eyebrow approach within 72 hours after SAH. Seven multiple aneurysm patients harbor 15 aneurysms. Forty one aneurysms were treated with clippings. All 11 patients of eyebrow surgery group(ESG) were in H-H grade IV, 3 in Fisher grade III and 8 in Fisher grade IV. Among 24 patients of pterional approach group(PAG), 20 were in H-H grade IV and 4 in H-H grade V, 3 were in Fisher grade III and 21 in Fisher grade IV. Overall favorable outcome was achieved in 41.7% and 54.5% in PAG and ESG, respectively. Favorable outcome of H-H grade IV in PAG showed 45.0%. Overall mortality rate was 14.3%. CONCLUSION: It is concluded that the clinical outcome of early and minimally invasive aneurysmal surgery using eyebrow incision in the selected poor grade aneurysm patients can be compatible with that of conventional pterional surgery.

Periorbital Cerebrospinal Fluid Collection after Orbital Roof Craniotomy and Superolateral Orbital Craniotomy

OBJECTIVE: The aims of this study are to review the incidence of cerebrospinal fluid(CSF) collection complicating the simplified anterior skull base approaches via an eyebrow incision and to identify factors that influence its occurrence and treatment. METHODS: The authors retrospectively analyzed the clinical records and radiologic data of 47 cases(45 patients) who underwent superolateral orbital craniotomy or orbital roof craniotomy via an eyebrow incision at the Eulji Medical Center from September 1998 to August 2002. Forty-three cases were anterior circulation aneurysms and four cases were brain tumors. RESULTS: Significant periorbital CSF collection occurred in 13 cases(11 aneurysms, 2 brain tumors). It was managed with aspiration(8 cases), aspiration and lumbar drainage(2 cases), and dural repair(3 cases). There was no statistically significant difference in operative approaches and patient's characteristics. Periorbital CSF collection occurred in one(16.7%) of six cases using preventive lumbar CSF drainage over two days and in 12 (29.3%) out of 41 cases without it(p>005). CONCLUSION: The authors suggest that careful dissection and water-tight closure of frontal dura, sealing with fibrin glue and compressive dressing of operative wounds are important for the prevention of this complication. However, statistically not significant, preventive lumbar CSF drainage seem to be effective. Aspiration and/or lumbar drainage seem to be sufficient for management of postoperative CSF collection and dural repair could be reserved for refractory cases.