New Surgical Technique Accesses the Brain Through the Eyelid

Transpalpebral orbitofrontal craniotomy, a minimally invasive technique used to access to the skull and brain through the eyelid, sharply contrasts with more laborious, physically damaging, and invasive traditional forms of entry used in brain surgery.

Developed by researchers at Johns Hopkins University (JHU; Baltimore, MD, USA), the new mini-craniotomy technique requires surgeons to remove only a small, 1.2 cm² - 2.5 cm² section of the cranium just above the eyebrow (which is later replaced), to gain access to the brain area. Once access to the brain is secured, a microscope- and computer-guided endoscope is used to thread additional surgical instruments into the soft brain tissue, guided by computerized tomography (CT) and magnetic resonance imaging (MRI) scans of the brain. The new approach reduces surgical time, poses less risk of possible infection (due to the less-invasive surgery involved), and requires less time for recovery, usually an overnight stay instead of the four days or longer in the hospital in conventional access.

Transpalpebral orbitofrontal craniotomy is indicated for treating common postsurgical complications such as cerebrospinal spinal fluid leak into the sinus cavity, a result of previous, more invasive skull surgery. Other proposed uses are tissue biopsy, brain aneurysm repair, and removal of larger brain tumors that cannot easily reached by traditional skull surgery or a transnasal and sinus cavity approach. The surgeons were also able to remove a potentially cancerous tumor in a baby whose skull was deemed too small to endure the physical trauma associated with major brain surgery. The study describing the new technique was published in the June 2010 issue of the Journal of Otolaryngology - Head and Neck Surgery.

"Going through the eyelid offers a simpler, more direct route to the middle and front regions of the brain than traditional skull-based surgery,” said lead author facial plastic and reconstructive surgeon Kofi Boahene, M.D. "This minimally invasive approach also avoids the major head trauma typically associated with brain surgery.”

"The transpalpebral approach is a very viable and practical option for thousands of surgeries done each year in the United States that involve problems deeply seated behind the eyes or at the front of the brain,” added senior author neurosurgeon Alfredo Quinones-Hinojosa, M.D. "The minicraniotomy can also be used to correct deformities or skull bones broken by trauma and car accidents.”

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