Overview: The supraorbital approach uses an incision within the eyebrow, to create a small (1.5 - 2 cm x 2.5 cm) bony opening above the orbit.  It is used to remove brain tumors under or within the frontal lobes, temporal lobe and near the optic nerves and pituitary gland. BTC neurosurgeons often use the eyebrow approach instead of traditional larger fronto-temporal or bi-frontal craniotomies that are still frequently used in many Centers.

The eyebrow approach differs from a traditional craniotomy in that it requires less dissection of the temporalis (chewing) muscle, a smaller bony opening and minimal brain manipulation, thereby promoting a rapid, less painful recovery. The cosmetic result is also generally excellent. 

Disorders Treated: The supraorbital approach is used for removal of many anterior skull base tumors including meningiomas (olfactory groove, planum and tuberculum regions), craniopharyngiomas and other tumors near the optic nerves and pituitary gland, such as epidermoid cysts. It can also be used for tumors in the frontal and temporal lobes such as gliomas (astrocytomas, GBM) and metastatic brain tumors. It is often used instead of the endonasal endoscopic approach when a tumor is too large, engulfing the optic nerves or intracranial arteries or extending too far away from midline. In some patients depending upon tumor size and location, an alternative minimally invasive  approach or a conventional craniotomy may be recommended.

Our Experience and Approach: BTC Director, Dr. Daniel Kelly has an extensive experience with the eyebrow craniotomy for a wide variety of brain and skull base tumors. Dr. Kelly and his team were the first to publish a comparison study of the eyebrow and endonasal approaches for removal of meningiomas and craniopharyngiomas.  This important paper, published in 2009, highlights the advantages and disadvantages of these two keyhole approaches and provides recommendations for the optimal route based on tumor type, size, location and surgeon experience. Because of our large experience with both of these approaches and other minimally invasive and conventional craniotomies, we can tailor the ideal approach for each patient.

Multidisciplinary Care:For patients with incompletely removed or aggressive brain or skull base tumors, additional treatments such as radiosurgery and/or chemotherapy may be needed. To learn more, go to Comprehensive Brain Tumor Program.

See more: Endoscopic & keyhole surgery videos on BTC YouTube Channel