• Haiyong He, Wensheng Li, Meiqin Cai, Lun Luo, Manting Li, Cong Ling, Tengchao Huang, Huasheng Yang, and Ying Guo.
• Department of Neurosurgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
• World Neurosurg. 2019 Sep 1; 129: e279-e285.

ObjectiveThe pterional approach (PA) has been used to remove cranio-orbital lesions that have communicated via the supraorbital fissure (SOF). The supraorbital eyebrow approach (SEA) has become increasingly popular as a minimally invasive approach. However, few reports have examined the SEA for cranio-orbital lesions. We assessed the relative advantages, disadvantages, and selection criteria for these 2 approaches.MethodsThe data from all consecutive patients who had undergone removal of a cranio-orbital lesion that communicated via the SOF using the PA or SEA were analyzed.ResultsOf the 25 patients, 13 had undergone surgical resection using the SEA and 12 had undergone resection using the PA. The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision (P < 0.05). Proptosis had improved significantly in all the patients. No significant differences were found in the total resection rates, visual outcomes, recovery of ptosis, or other new surgically related complications between the 2 groups (P > 0.05). All the patients were followed up for an average of 21.9 months. One patient in each group had developed recurrence or progression that required radiotherapy. The disease of the other patients with subtotal resection was stable or atrophic.ConclusionThe SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision. The SEA might be a more minimally invasive option for lesions communicating via the SOF without obvious hyperostosis. The PA might be more reasonable for lesions with obvious hyperostosis and more extensive lesions in the cavernous sinus.Copyright © 2019 Elsevier Inc. All rights reserved.

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