Minimally Invasive Transpalpebral “Eyelid” Approach to the Anterior Circulation Aneurysms: Forty Cases Experience

Khaled M. Aziz1, Sanjay Bhatia, MD1, Mohamed Hammad, MD1, Erik Happ, MD1

1Pittsburgh, PA United States

Keywords: aneurysm, aneurysm repair, outcome, technique, anterior communicating artery

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     Concept of minimally invasive approaches for anterior circulation aneurysms has been evolving during the past two decades.
     Supra orbital frontal mini-craniotomy with or without including orbital ridge is commonly utilized approach.
     We describe our experience with transpalpebral eyelidincision which utilizes natural upper eyelid crease to obtain access to anterior cranial fossa through subfrontal-supraorbital corridor. This approach minimizes the cosmetic problems with the supraciliary or transciliary incisions. The eyelid approach reduce risk of injury to frontalis branch of facial nerve. We will review our experience with forty anterior circulation aneurysms sized from 5-15 mm, not including middle cerebral artery aneurysms.
     Extracranial drilling of the greater sphenoid wing exposes the frontal dura, temporal dura, and peri-orbita spheno-orbital key-hole. One piece fronto-orbital craniotomy is performed in all cases with bone flap about 2.5 cm height. After the dura is opened a panoramic view of anterior cranial fossa floor achieved, extending from the contralateral to the epsilateral oculomotor nerve. We are describing the approach, technique in step-by-step fashion, discuss the results of our fourty aneurysms as well as the advantages of transpalpepbral approach. Seven aneurysms required optic foramnotomy and anterior clinoidectomy. This is the largest series published in the literature utilizing this unique approach with excellent cosmetic outcome in 39/40 patients, 1/40 radiological stroke without deficit, 4/40 complications (eyelid hematoma, superficial infection, CSF leak).
     This is a retrospective study.
     The transpalpebral approach provides dissection in natural anatomical planes, preserving frontalis muscle, avoids injury to VII nerve branches.
     It also results in excellent cosmetic outcome.


Project Roles:

K. Aziz (), S. Bhatia (), M. Hammad (), E. Happ ()