Addressing Meningiomas through Supraorbital Craniotomy: A Case Series

Introduction: The supraorbital keyhole approach aims to provide adequate access to anterior skull base lesions while minimizing the extent of bony opening and brain retraction. The supraorbital craniotomy is effective in accessing many extra-axial tumors of the anterior skull base, including tuberculum sellae and olfactory groove meningiomas. We aimed to review a single center series of supraorbital approaches for anterior skull base meningiomas.

Methods: Retrospective data was collected for 21 patients who underwent supraorbital craniotomy for the removal of anterior skull base meningioma at Keck Hospital of USC and Los Angeles General Medical Center between 2012-2022. Intraoperative and postoperative outcomes were assessed.

Results: Patients had a mean age of 60.1 years old and 76.2% were females. The most common tumor origin was a tuberculum sellae meningioma; olfactory groove was the next most prevalent. Four tumors were recurrent after prior operation. Gross total resection was achieved in 57% (N=12) with subtotal or near-total resection in the remaining 43% (N=9). The majority of meningiomas were WHO grade 1, with 14% (N=3) grade 2 and 5% (N=1) grade 3. Mean tumor diameter was 2.57 cm; average consistency was a grade of 3.17. No patients experienced intraoperative complications or postoperative CSF leaks. Eighty-one percent (N=17) reported pre-operative vision loss, ranging from blurry vision to acute complete loss of vision. Seventy-one percent (n=15) reported improvement in vision, 5% (N=1) reported stable vision, and 24% reported worsened vision after surgery. Nine percent (N=2) reported decreased olfaction and taste, which improved after surgery. Complications included 1 infection, frontalis palsy (N=2), and 1 internal carotid artery injury that was repaired without neurological sequelae.

Conclusion : The supraorbital approach is a safe, effective approach in resection of anterior skull base meningiomas. The majority of patients experienced improvement in vision, and the number of intraoperative and postoperative complications were relatively low.