Image-guided transorbital roof craniotomy via a suprabrow approach: A surgical series of 72 patients

OBJECTIVE: Many subfrontal and orbitofrontal craniotomy techniques have bee n developed. We present our results with the transorbital roof craniotomy, a frontal craniotomy that incorporates the orbital roof and is performed vi a a suprabrow incision. This technique was used in 72 patients, primarily f or tumor resection. METHODS: Charts were retrospectively reviewed for all patients undergoing t ransorbital procedures. A total of 72 patients underwent 82 transorbital cr aniotomies from September 1995 to July 1999. The primary indication for the transorbital approach was mass lesion of the orbit, anterior fossa, or par asellar region. RESULTS: A total of 47 women and 25 men with a mean age of 53 years underwe nt 82 procedures. The primary pathological finding was meningioma, which oc curred in 40 patients (55.6%), followed by craniopharyngioma (6.9%), pituit ary macroadenoma (6.9%), schwannoma (5.5%), and hemangioma (5.5%). Simpson Grade I or II resection was achieved in 54% of patients, with Simpson Grade III to V resection achieved in the remaining 46%. Forty-one patients prese nted with visual loss in 43 cases, with 44.2% experiencing postoperative vi sual improvement, 46.5% remaining unchanged, and 9.3% worsening. Overall mo rbidity was 18.4%, with cerebrospinal fluid leak being the most common comp lication (6.6%). No patients died. CONCLUSION: The transorbital roof craniotomy is an evolutionary approach th at provides excellent exposure to the orbit, anterior fossa, and parasellar region with little significant morbidity and, in our series, no mortality. Although we have used this approach primarily for resection of mass lesion s, future directions for this procedure will likely lie in treating vascula r lesions and lesions of the interpeduncular fossa.