Journal article
A Review of the Literature on the Transciliary Supraorbital Keyhole Approach.
- Zumofen DW Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Diagnostic and Interventional Neuroradiology Section, Department of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland. Electronic address: daniel.zumofen@usb.ch.
- Rychen J Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- Roethlisberger M Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- Taub E Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- Kalbermatten D Department of Plastic, Reconstructive and Aesthetic Surgery, Basel University Hospital, Basel, Switzerland.
- Nossek E Division of Neurosurgery, Maimonides Medical Center, Brooklyn, New York, USA.
- Potts M Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
- Guzman R Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- Riina HA Department of Neurological Surgery, New York University Langone Medical Center, New York, New York, USA.
- Mariani L Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
- 2016-12-20
Published in:
- World neurosurgery. - 2017
Eyebrow skin incision
Minimally invasive neurosurgery, keyhole neurosurgery
Supraorbital craniotomy
Transciliary supraorbital approach
Computed Tomography Angiography
Craniotomy
Eyebrows
Humans
Intracranial Aneurysm
Magnetic Resonance Angiography
Minimally Invasive Surgical Procedures
Orbit
Treatment Outcome
English
BACKGROUND
Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach.
METHODS
We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection.
RESULTS
Eight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable.
CONCLUSIONS
This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.
Conventional craniotomy approaches involve substantial soft tissue manipulation that can cause complications. The transciliary supraorbital keyhole approach was developed to avoid these complications. The aim of this review is to evaluate the safety and the effectiveness of the transciliary supraorbital keyhole approach.
METHODS
We searched the PubMed/Medline database for full-text publications from 1996 onward containing data on 100 or more cases of aneurysm clipping or tumor resection by the transciliary supraorbital keyhole approach. The primary outcome was the incidence of approach-related complications. The secondary outcomes were the aneurysm occlusion rate and the extent of tumor resection.
RESULTS
Eight publications met the eligibility criteria. All publications were of the retrospective case-series or case-cohort type without any independent assessment of outcomes. The risk of bias at the individual study level may thus have influenced any conclusions drawn from the overall study population, which included 2783 patients with 3085 lesions (2508 aneurysms and 577 tumors). Approach-related complications included 3.3% cerebrospinal fluid collection or leak, 4.3% permanent and 1.6% temporary supraorbital hypesthesia, 2.9% permanent and 1% temporary facial nerve palsy, and 1% wound healing disturbance or wound infection. Complete aneurysm clipping was achieved in 97% of cases. Complete tumor resection in 90% of cases. The overall surgical revision rate was 2.5%. The esthetic outcome was typically reported as highly acceptable.
CONCLUSIONS
This approach may represent a safe, effective, and less invasive alternative to conventional craniotomies in experienced hands and for a well-selected subset of patients. However, higher-level evidence is needed to confirm this hypothesis.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.wneu.2016.10.110
- PMID 27989977
- Persistent URL
- https://susi.usi.ch/global/documents/246763
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