Dhandapani Sivashanmugam, Wankhede Lomesh S
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Neurol India. 2021 Mar-Apr;69(2):441-445. doi: 10.4103/0028-3886.314520.
The classical eyebrow supraorbital keyhole craniotomy has limited working volume due to the thick incurving of the frontal bone necessitating generous drilling of the frontal base. However, the basal variant with sectioning of the orbital rim results in increased periorbital edema.
We describe a novel orbital rim sparing single-piece fronto-orbital keyhole approach, probably the first such report with a comparative review of relevant literature.
Following eyebrow incision, bidirectional drilling with a ball tip behind the fronto-zygomatic suture exposes the periorbita and frontal dura, with orbital roof in-between. The craniotomy is fashioned with an angled fronto-orbital cut parallel to and sparing the orbital rim with dura-guard over the periorbita, a frontal cut over the dura, and an optional cut along the lateral orbital roof from within the burr hole. A comparative review of this technique with traditional methods is also carried out.
Compared to the classical supraorbital keyhole, this minimally invasive approach yields a wider basal exposure with greater working volume for intracranial and orbital lesions. Compared to the basal variant of keyhole fronto-orbital approach, this technique results in the least disturbance to periorbita's attachment with the orbital margin, maintenance of orbital contour, better cosmesis with use of simple tools and self-fitting flap.
The orbital rim sparing single-piece fronto-orbital keyhole craniotomy is an easy and novel minimally invasive approach with greater working volume without the disadvantages of sectioning the orbital rim.
经典的眉弓上眶上锁孔开颅术由于额骨的厚向内弯曲，需要对额骨基部进行大量钻孔，导致工作空间有限。然而，切开眶缘的基部变体导致眶周水肿增加。
我们描述一种新型的保留眶缘的单片额眶上锁孔入路，可能是首例此类报告，并对相关文献进行比较综述。
沿眉弓切口，在额颧缝后方用球头钻双向钻孔，暴露眶骨膜和额部硬脑膜，其间为眶顶。开颅术采用与眶缘平行且保留眶缘的成角度额眶切口，眶骨膜上覆盖硬脑膜保护装置，硬脑膜上做额部切口，以及从钻孔内沿眶顶外侧做一个可选切口。还对该技术与传统方法进行了比较综述。
与经典的眶上锁孔开颅术相比，这种微创入路能获得更宽的基部暴露，为颅内和眶内病变提供更大的工作空间。与眶上锁孔额眶入路的基部变体相比，该技术对眶骨膜与眶缘附着的干扰最小，能维持眶部轮廓，使用简单工具和自适配皮瓣可获得更好的美容效果。
保留眶缘的单片额眶上锁孔开颅术是一种简便新颖的微创入路，工作空间更大，且无切开眶缘的缺点。
