Senior Consultant Neurosurgeon Apollo Hospitals Chennai
Introduction: It is widely known that the minisupraorbital keyhole technique is not suitable for large or deeply located lesions, and especially those of a complex anatomy with a pronounced mass effect. Nevertheless, we wish to present a challenging case series which includes large tumors, complex aneurysms, as well as a new technique to resect insular glioma, all managed with minimal approach related morbidity.
Methods: We present seven challenging cases, including large olfactory groove meningioma, tuberculum sellae meningioma, massive frontal glioblastoma multiforme (GBM), deep basal ganglionic GBM, traumatic massive large frontal intracerbral hematoma, a ruptured blister anterior communicating artery aneurysm, and a large dominant operculo insular glioma. All were approached using the minisupraorbital keyhole technique. This series includes a first ever application of a skull base approach to the insular glioma, which traditionally presents access challenges due to its deep-seated location.
Results: All seven patients were successfully treated using the minisupraorbital keyhole approach, with no permanent approach-related morbidity. Surgical objectives were achieved in all cases without any requirement of revision or conversion of the plan to a more conventional approach. Postoperative imaging and clinical outcomes were as desired with particular emphasis on cosmesis. Duration of stay in the hospital was lesser compared to that described in literature for a conventional approach.
Conclusion : This case series serves as a proof-of-concept for expanding the use of the minisupraorbital keyhole approach to more challenging and complex cranial pathologies. The successful outcomes suggest that this approach, typically reserved for smaller lesions, may be safely applied to large, complex tumors and aneurysms. Our findings highlight the potential to broaden the application of this minimally invasive technique in neurosurgery.
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