Dlouhy Brian J, Chae Michael P, Teo Charles
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and.
J Neurosurg Pediatr. 2015 Jan;15(1):12-9. doi: 10.3171/2014.10.PEDS1430.
The supraorbital eyebrow approach utilizes an eyebrow skin incision to fashion a supraorbital craniotomy for exposure of the subfrontal corridor. This provides anterolateral access to surgical lesions in the anterior cranial fossa, parasellar regions, brainstem, and medial temporal lobe. With use of the endoscope, further areas can be accessed. This approach has been applied effectively in adults, but questions remain about its use in children-specifically with regard to adequate working space, effectiveness for achieving the desired results, cosmesis, and complications.
The authors conducted a retrospective review of more than 450 cases involving patients of all ages who had undergone a supraorbital eyebrow approach performed by the senior author (C.T.) from 1995 to 2013. Only cases involving patients younger than 18 years with a minimum follow-up of 6 weeks were included in this study. All inpatient and outpatient records were retrospectively reviewed and clinical/operative outcomes, cosmetic results, and complications were recorded. In the present article, the authors briefly describe the surgical approach and highlight any differences in applying it in children.
Fifty-four pediatric patients who had undergone a supraorbital eyebrow approach met inclusion criteria. The pathological conditions consisted mostly of tumors or other resectable lesions. In a total of 51 resectable lesions, 44 surgeries resulted in a gross-total (100%) resection and 7 cases resulted in subtotal (50%-99%) resection. The endoscope assisted and expanded visualization or provided access to areas not reached by standard microscopic visualization in all cases. Cosmetic outcomes were excellent. In all cases, the incisional scar was barely visible at 6 weeks. In 3 cases a minor bone defect was observed on the forehead. Given the small size of the frontal sinus in children, no frontal sinus breaches occurred. Additionally, no CSF leak or wound infection was identified.
The supraorbital eyebrow approach is extremely effective in achieving desired results in properly selected cases in patients of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.
眶上眉弓入路利用眉部皮肤切口形成眶上开颅术，以暴露额下通道。这为前颅窝、鞍旁区域、脑干和颞叶内侧的手术病变提供了前外侧入路。使用内窥镜可进入更多区域。该入路已在成人中得到有效应用，但在儿童中的应用仍存在一些问题，特别是关于足够的工作空间、实现预期效果的有效性、美容效果和并发症。
作者对1995年至2013年由资深作者（C.T.）实施眶上眉弓入路的450多例各年龄段患者进行了回顾性研究。本研究仅纳入年龄小于18岁且至少随访6周的患者病例。对所有住院和门诊记录进行回顾性审查，并记录临床/手术结果、美容效果和并发症。在本文中，作者简要描述了手术入路，并强调了在儿童中应用该入路的任何差异。
54例接受眶上眉弓入路的儿科患者符合纳入标准。病理情况主要为肿瘤或其他可切除病变。在总共51例可切除病变中，44例手术实现了全切（100%）切除，7例为次全（50%-99%）切除。在所有病例中，内窥镜辅助并扩大了视野，或提供了标准显微镜视野无法到达区域的通路。美容效果极佳。在所有病例中，6周时切口瘢痕几乎不可见。3例患者额部观察到轻微骨缺损。鉴于儿童额窦较小，未发生额窦破裂。此外，未发现脑脊液漏或伤口感染。
眶上眉弓入路在所有儿科年龄范围（从婴儿到青少年）的适当选择病例中，实现预期效果非常有效。有足够的空间用于内窥镜和所有器械，允许内窥镜辅助和双手手术技术。美容效果极佳，与该入路相关的并发症极少。
