Department of Neurosurgery, Allegheny General Hospital, Drexel College of Medicine, Pittsburgh, Pennsylvania 15212, USA.
Neurosurgery. 2011 Dec;69(2 Suppl Operative):ons195-206; discussion 206-7. doi: 10.1227/NEU.0b013e31821c3ea3.
Supra orbital frontal minicraniotomy is one of the most commonly used minimally invasive approaches for anterior cranial fossa lesions.
To describe our experience with the transpalpebral "eyelid" incision to obtain access to the anterior cranial fossa.
We describe the approach and technique of the transpalpebral eyelid incision in a step-by-step fashion and discuss the results of 40 cases for which the eyelid incision was used. We retrospectively reviewed the charts of these patients to analyze outcomes with regard to opening and closing time, length of hospital stay, residual aneurysm or Simpson grade for resection, complications, and cosmetic result.
We treated 31 anterior circulation aneurysms (28 unruptured and 3 ruptured), 7 anterior skull base meningiomas, 1 frontal low-grade glioma, and 1 frontal cavernoma using the transpalpebral incision. Opening time was about 45 to 60 minutes, and closure time from dura to skin was about 45 to 60 minutes. The hospital length of stay was similar to that in our open craniotomy cases. No residual aneurysm was demonstrated in the follow-up studies of all 31 aneurysms. Simpson grade I resection was achieved in 6 meningiomas. Complications included 1 postoperative eyelid hematoma, 2 postoperative infections, and a subclinical stroke discovered on postoperative imaging. Excellent cosmetic outcome was accomplished in 39 of 40 patients.
The transpalpebral approach provides dissection in natural anatomical planes, affords preservation of the frontalis muscle, avoids injury to nerve VII branches, and results in an excellent cosmetic outcome.
眶上额微创开颅术是一种常用于前颅窝病变的微创入路方法。
描述我们经眶皮“眼睑”切口进入前颅窝的经验。
我们以逐步的方式描述经眶皮眼睑切口的方法和技术，并讨论了 40 例使用眼睑切口的病例结果。我们回顾性分析了这些患者的图表，分析了手术时间、住院时间、残余动脉瘤或切除的 Simpson 分级、并发症和美容效果等结果。
我们使用经眶皮切口治疗了 31 例前循环动脉瘤（28 例未破裂和 3 例破裂）、7 例前颅底脑膜瘤、1 例额叶低级别胶质瘤和 1 例额叶海绵状血管瘤。手术切开时间约为 45 至 60 分钟，从硬脑膜到皮肤的缝合时间约为 45 至 60 分钟。住院时间与我们的开颅手术病例相似。所有 31 例动脉瘤的随访研究均未显示残余动脉瘤。6 例脑膜瘤达到 Simpson 分级 I 切除。并发症包括 1 例术后眼睑血肿、2 例术后感染和 1 例术后影像学发现亚临床卒中。39 例患者中，39 例获得了良好的美容效果。
经眶皮入路在自然解剖平面进行解剖，保留额肌，避免了面神经 VII 分支的损伤，并且获得了良好的美容效果。
