American Association of Plastic Surgeons

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Novel Transpalpebral "Eyelid" Approach for Supraorbital Frontal Craniotomy and Access to the Anterior Cranial Fossa
Kerry A. Morrison, MD, Scott J. Farber, MD, Howard A. Riina, MD, David A. Staffenberg, MD.
NYU Langone Medical Center, NEW YORK, NY, USA.

PURPOSE: The transpalpebral “eyelid” approach is a novel alternative to traditional incisions for supraorbital frontal craniotomy and access to the anterior cranial fossa. This is the first report in the plastic surgery literature of such a surgical technique for accessing the anterior cranial fossa.
METHODS: A retrospective review was performed of patients who underwent supraorbital frontal craniotomy using an anterior skull base approach with transpalpebral exposure over seven years by a single plastic surgeon (D.A.S.). Surgical techniques, medical co-morbidities, intra-operative and long-term complications were assessed. Pre- and post-operative imaging were evaluated.
RESULTS: Nineteen patients (mean age 52±12 years, 52% male) were included. For operative indications, 80% (15) had anterior communicating aneurysms with a mean size of 5.36±1.91 mm, 10% (2) meningiomas, 5% (1) dural fistula, and 5% (1) orbital hemangioma. Notably, 58% (11) had a smoking history. No intra-operative complications were encountered, and no cases were converted to traditional open approaches. Mean length of hospital stay was 3.3±1.5 days. Post-operative imaging revealed no residual or recurrent aneurysms or disease. Mean follow-up time was 47.1±28.4 months. Long-term complications were limited to two patients requiring re-operation for aesthetic considerations related to palpable hardware with no further sequelae. No long-term neurological complications or infections occurred.
CONCLUSION: This transpalpebral technique is an excellent, minimally invasive, and innovative alternative to approach lesions of the anterior cranial fossa. This approach provides dissection in well-defined anatomical planes, affords preservation of the frontalis muscle, avoids facial nerve injury, and yields superior aesthetic outcomes to traditional craniotomy incisions.


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