The Bilateral Supraorbital Minicraniotomies for Total Removal of Giant Suprasellar-Subchiasmatic Tumors

* Department of Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

Affiliation : Parin Mahatano MD*

Minimally invasive supraorbital approach through minicraniotomy have been proposed and developed for the treatment of anterior cranial fossa pathology and lesions around sellae. The author has used this concept of smaller operative corridors to treat the suprasellar tumors. In cases of large suprasellar tumors, mainly of subchiasmatic location, that radical removal could not be achieved with unilateral approach, an additional contralateral supraorbital approach was proceeded to accomplish radical removal. Through bicoronal incision, approach via bilateral supraorbital minicraniotomies was used to treat three cases of giant suprasellar-subchiasmatic tumors, with the greatest dimension of more than 4 cm, between 2005 and 2010. The result of treatment is satisfactory. There was no operative mortality or new major neurological deficit. All tumors were totally removed with marked improvement of visual deficit in two patients. No adjuvant radiotherapy was given. All were recurrence free 18 months, 4 years, and 5 years after the surgery. The major advantage of this approach is the excellent visualization and identification of the plane between the tumor and contralateral optic nerve through each corridor. This will facilitate complete decompression of both optic nerves and enhance radical removal of the tumor while avoiding risk of injury to the nearby neurovascular structures. However, the approach-related disadvantage is the risk of olfactory dysfunction from bilateral olfactory nerve damage, which can be further improved by a refinement of the techniques.

Keywords : Bilateral subfrontal approach, Bilateral supraorbital approach, Bilateral supraorbital minicraniotomies, Giant suprasellar-subchiasmatic tumors

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