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Surgical Experience with Frontolateral Keyhole Craniotomy through a Superciliary Skin Incision

2001; Lippincott Williams & Wilkins; Volume: 49; Issue: 2 Linguagem: Inglês

10.1227/00006123-200108000-00053

1524-4040

Raúl Andrès Pérez Falero, Juan Carlos Bermejo Sánchez, Enrique de Jongh Cobo,

Craniofacial Disorders and Treatments

To the Editor: After a careful reading of the article by Czirják and Szeifert (2), we think that this approach is a modification of the original technique for the supraorbital transciliary frontolateral approach described by Sánchez-Vázquez at the annual meeting of the Congress of Neurological Surgeons in 1996 and modified by the same author 3 years later (3). We believe that the technique of Sánchez-Vázquez is aesthetically superior to the version of Czirják and Szeifert (2). In their 1999 article, in which more than 60 procedures are reported, Sánchez-Vázquez et al. (3) report good results in the functional and aesthetic sense. The approach of Sánchez-Vázquez et al. is transciliary instead of superciliary. The surgical incision begins at the midline and extends over the line of the eyebrow to the tail of the eyebrow, where the anterior edge of the temporal muscle is revealed. The surgeon must take care in positioning the scalpel with respect to the pilose follicles. This last maneuver avoids alopecia in the cicatrix and, consequently, a visible scar. On the other hand, even if the patient experiences temporary paralysis and anesthesia of the frontal skin because of sectioning of the supraorbital nerve and artery and traction on the frontotemporal branch of the facial nerve, movement and sensation are recovered after 2 to 3 months. It seems evident that the transciliary technique provides aesthetically superior results, and, like the supraciliary version, it guarantees adequate exposure of the optic chiasm and adjacent areas. We have developed a modification of this technique in which the neurovascular bundle of the supraorbital area is spared with a vertical incision lateral to the supraorbital foramen and then subperiosteal dissection. Thus, we can preserve the sensory innervation of this region (1). Raúl Andrès Pérez Falero Juan Carlos Bermejo Sánchez Enrique de Jongh Cobo