• Robert Reisch, Axel Perneczky, and Ronald Filippi.
• Department of Neurosurgery, Johannes-Gutenberg University Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany.
• Surg Neurol. 2003 Mar 1; 59 (3): 223-7.

BackgroundThe enormous development of microsurgical techniques and instrumentation together with preoperative planning using the excellent preoperative diagnostic facilities available, enables neurosurgeons to treat more complicated diseases through smaller and more specific approaches.MethodsThe technical details of the supraorbital key-hole craniotomy are described in this article as it has been evolving in our experience for more than 10 years. After an eyebrow skin incision with careful soft tissue dissection and single frontobasal burr-hole trephination, a supraorbital craniotomy is carried out with a diameter of about 1.5 x 2.5 cm. As a real frontolateral approach, the supraorbital craniotomy avoids removal of the orbital rim, the lesser sphenoid wing or the zygomatic arch.Results And ConclusionsThe supraorbital craniotomy allows wide intracranial exposure of the deep-seated supra- and parasellar region, according to the concept of key-hole approaches. The limited craniotomy requires minimal brain retraction thus significantly decreasing approach-related morbidity. In addition, the short skin incision within the eyebrow, the careful soft tissue dissection, and the single burr hole trephination result in a pleasing cosmetic outcome.

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