1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC.
2Georgetown University School of Medicine, Washington, DC.
Neurosurg Focus. 2024 Apr;56(4):E13. doi: 10.3171/2024.1.FOCUS23878.
Eyebrow supraorbital craniotomy is a versatile keyhole technique for treating intracranial pathologies. The eyelid supraorbital approach, an alternative approach to an eyebrow supraorbital craniotomy, has not been widely adopted among most neurosurgeons. The purpose of this systematic review and meta-analysis was to perform a pooled analysis of the complications of eyebrow or eyelid approaches for the treatment of aneurysms, meningiomas, and orbital tumors.
A systematic review of the literature in the PubMed, Embase, and Cochrane Review databases was conducted for identifying relevant literature using keywords such as "supraorbital," "eyelid," "eyebrow," "tumor," and "aneurysm." Eyebrow supraorbital craniotomies with or without orbitotomies and eyelid supraorbital craniotomies with orbitotomies for the treatment of orbital tumors, intracranial meningiomas, and aneurysms were selected. The primary outcomes were overall complications, cosmetic complications, and residual aneurysms and tumors. Secondary outcomes included five complication domains: orbital, wound-related, scalp or facial, neurological, and other complications.
One hundred three articles were included in the synthesis. The pooled numbers of patients in the eyebrow and eyelid groups were 4689 and 358, respectively. No differences were found in overall complications or cosmetic complications between the eyebrow and eyelid groups. The proportion of residuals in the eyelid group (11.21%, effect size [ES] 0.26, 95% CI 0.12-0.41) was significantly higher (p < 0.05) than that in the eyebrow group (6.17%, ES 0.10, 95% CI 0.08-0.13). A subgroup analysis demonstrated significantly higher incidences of orbital, wound-related, and scalp or facial complications in the eyelid group (p < 0.05), but higher other complications in the eyebrow group. Performing an orbitotomy substantially increased the complication risk.
This is the first meta-analysis that quantitatively compared complications of eyebrow versus eyelid approaches to supraorbital craniotomy. This study found similar overall complication rates but higher rates of selected complication domains in the eyelid group. The literature is limited by a high degree of variability in the reported outcomes.
眉弓眶上锁孔入路是一种治疗颅内病变的多功能微创技术。与眉弓眶上锁孔入路相比，眼睑眶上锁孔入路在大多数神经外科医生中尚未得到广泛应用。本系统评价和荟萃分析的目的是对眉弓或眼睑入路治疗动脉瘤、脑膜瘤和眶内肿瘤的并发症进行汇总分析。
通过关键词（如“眶上”、“眼睑”、“眉毛”、“肿瘤”和“动脉瘤”）在 PubMed、Embase 和 Cochrane 评价数据库中进行文献系统检索，以确定相关文献。选择行眶上锁孔入路（包括或不包括眶切开术）和眼睑眶上锁孔入路（包括或不包括眶切开术）治疗眶内肿瘤、颅内脑膜瘤和动脉瘤的病例。主要结局是总体并发症、美容并发症和残留动脉瘤和肿瘤。次要结局包括 5 个并发症领域：眼眶、伤口相关、头皮或面部、神经和其他并发症。
共纳入 103 篇文章进行综合分析。眉弓组和眼睑组的患者人数分别为 4689 例和 358 例。两组在总体并发症或美容并发症方面无差异。眼睑组（11.21%，效应量[ES]0.26，95%CI0.12-0.41）的残留比例显著高于眉弓组（6.17%，ES0.10，95%CI0.08-0.13）（p<0.05）。亚组分析显示，眼睑组眼眶、伤口相关和头皮或面部并发症的发生率显著较高（p<0.05），而眉弓组其他并发症的发生率较高。行眶切开术会显著增加并发症风险。
这是首次对眉弓与眼睑入路行眶上锁孔入路治疗效果进行比较的荟萃分析。本研究发现两组总体并发症发生率相似，但眼睑组特定并发症领域的发生率较高。由于报告的结果存在很大的变异性，文献受到限制。
