Trans-supraorbital keyhole appraoch microsurgery with an eyebrow incision for sellar tumors: Report of 24 cases / 中国微创外科杂志

ABSTRACT

Objective To study the feasibility of trans-supraorbital keyhole approach microsurgery for sellar tumors.Methods The operation was conducted under combined intravenous general anesthesia and the patient was maintained at a dorsal position.A skin incision was made along the lateral eyebrow at 3.5~4.0 cm in length.The frontal muscle periosteous flap was draged upwards and the orbicularis muscle periosteous flap was dragged downwards.Then the tempotal muscle was dragged laterally.The position of the keyhole was located behind the temporal line.By using a milling cutter,a bone window 2 cm ? 3 cm in size was made medially.The inner margin of the supraorbital skull was shaped to expand the visual field of microsurgery.The cerebral dura mate was opened curvily,with the base directing to the orbital margin.The frontal lobe was elevated gently and the cerebrospinal fluid was drained.The tumor was fully exposed and resected.Results Total resection of tumor was achieved in 22 cases,and part of posterior tumor membrane remained in 2 cases of craniopharyngioma.Hypoadrenocorticism occurred in 1 case of ACTH adenoma after operation and a hormone replacement therapy was required. Temporary postoperative diabetes insipidus occurred in 8 cases and was relieved after 1 week.The postoperative urinary volume decreased significantly in 9 cases of preoperative diabetes insipidus.Visual disorder on the operational side was aggravated after operation in 1 case of tuberculum sellae meningioma,and was gradually improved after 1 week.No recurrence was observed under MRI examination in 18 cases at 3 months after operation.Conclusions Trans-supraorbital keyhole approach microsurgery is feasible,and it gives minimal operational trauma,thorough resection of tumor,and good cosmetic outcomes.