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PURPOSE:

To describe a technique combining the expertise of the oculoplastic orbital surgeon and the neurosurgeon which allows access to the posterior orbit, anterior fossa, cavernous sinus and suprasellar region with minimal brain manipulation.

METHODS:

A transorbital craniotomy through a suprabrow incision is performed removing part of the frontal bone and orbital roof as a single piece. This allows wide access with only minimal, if any, brain retraction. The superior, lateral and medial orbit is clearly visualized, as well as the apex of the orbit. The bone flap is replaced at the end of the case with Tantalum plates.


RESULTS:

A cavernous hemangioma at the orbital apex was removed without complications. The exposure was superb and allowed identification and preservation of orbital structures.


CONCLUSIONS:

Transorbital craniotomy allows for wide access to the posterior orbit and parasellar region and anterior fossa of the brain with minimal brain manipulation. The use of a suprabrow incision results in an excellent cosmetic result. There is minimal postoperative morbidity, which decreases hospitalization time.

http://www.ncbi.nlm.nih.gov/pubmed/10355834



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in this picture, we have an illustration of a trans-craniotomy. the surgical team have removed the scalp, and made a complete transverse cut of the cranium 1 cm above the level of the orbit and made a total circumferential cut.

after that, the cranium is removed, exposing the underlying meningeal layer (dura, arachnoid, pia).

very beautiful and simple procedure.

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