A supraorbital craniotomy is a neurosurgical technique that allows access to specific areas of the brain or skull base using a smaller incision. This method is considered minimally invasive compared to traditional open craniotomies. It is often referred to as an “eyebrow” craniotomy because the incision is typically made within the eyebrow, offering a more discreet cosmetic outcome.
The procedure involves creating a small bone opening, or bone flap, above the eye to reach lesions located in the front of the brain, around the pituitary gland, or at the skull base. This approach minimizes disruption to surrounding healthy brain tissue and reduces the extent of skull removal. The primary goal is to provide neurosurgeons with effective access to the target area, leading to less post-operative discomfort and a quicker recovery.
Conditions Treated by Supraorbital Craniotomy
The supraorbital craniotomy is a suitable surgical approach for addressing various conditions, particularly those located in the anterior cranial fossa and sellar/parasellar regions of the skull base. This includes specific types of brain tumors such as pituitary adenomas, which are growths on the pituitary gland often located behind the nose and eyes. Meningiomas, which are tumors arising from the protective membranes covering the brain and spinal cord, especially those near the front of the brain or skull base, can also be treated using this method.
Craniopharyngiomas, benign tumors that develop near the pituitary gland and hypothalamus, are also treated with this approach. Intracranial aneurysms, which are weakened, bulging spots on a brain artery, particularly those located in the anterior circulation, can also be candidates for repair via a supraorbital craniotomy. This approach offers direct access to these lesions, reducing the need for extensive brain retraction and minimizing manipulation of healthy brain tissue.
How the Surgery is Performed
A supraorbital craniotomy begins with the patient under general anesthesia, and their head is secured in a frame for stability. The surgeon makes a small incision, 2 to 3 centimeters in length, within the eyebrow, extending slightly beyond its lateral edge to avoid nerve damage. Dissection of soft tissues follows to expose the bone above the eye.
A single burr hole is drilled into the skull, behind the temporal line, serving as the entry point for creating the bone flap. Using specialized instruments, a small bone opening, around 1.5 x 2.5 cm, is created. This “keyhole” craniotomy allows access to the dura, the tough outer membrane protecting the brain, which is then carefully opened to expose the brain.
Neurosurgeons employ advanced technologies like neuronavigation during the procedure. This system uses pre-operative imaging (MRI or CT scans) to create a detailed map of the patient’s brain, guiding the surgeon in real-time to the precise location of the lesion. In some cases, endoscopy, using a tiny camera, may also be used to enhance visualization within the confined surgical space. The focused approach minimizes brain exposure and reduces brain retraction, which can decrease complications.
After the Surgery: Recovery and Care
Following a supraorbital craniotomy, patients spend 24 to 48 hours in the intensive care unit (ICU) for close monitoring before being transferred to a general neurosurgical ward. Pain management involves intravenous medications that are gradually transitioned to oral pain relievers as the patient recovers. Common post-operative symptoms include swelling around the incision site, headaches, and general fatigue, which are managed with medication and rest.
The hospital stay ranges from three to five days, depending on the patient’s recovery progress and the underlying condition treated. Patients are encouraged to mobilize early, sitting up and walking with assistance within a day or two after surgery to prevent complications like blood clots. Dietary intake is gradually advanced from clear liquids to a regular diet as tolerated.
Upon discharge, patients receive detailed instructions for wound care, medication management, and activity restrictions. Most individuals can gradually return to light daily activities within two to four weeks, though full recovery and return to strenuous activities may take several weeks to a few months. Follow-up appointments with the neurosurgeon are scheduled to monitor healing, assess neurological function, and discuss further treatment if necessary. Depending on the condition treated, some patients may benefit from rehabilitation therapies, such as physical therapy to regain strength and balance, or speech therapy if language or swallowing was affected.
Expected Outcomes and Potential Risks
The expected outcomes following a supraorbital craniotomy are favorable due to its minimally invasive nature. Patients can anticipate functional improvement related to the resolution of their underlying condition, whether it involves tumor removal or aneurysm repair. Many patients experience less post-operative pain and a faster recovery.
However, like any neurosurgical procedure, a supraorbital craniotomy carries inherent risks. Potential complications include infection at the surgical site, bleeding within the brain or around the surgical area, and cerebrospinal fluid (CSF) leakage, which is the clear fluid surrounding the brain and spinal cord.
Neurological deficits, such as temporary or permanent weakness, numbness, vision changes, or speech difficulties, are also possible, though rare. The surgical team carefully manages these risks through meticulous surgical technique, prophylactic antibiotics, and close post-operative monitoring. Patient evaluation and selection play a role in optimizing outcomes, ensuring that this specific approach is suitable for the individual’s condition and anatomy.