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      Contralateral Eyebrow Approach for Unilateral Suprasellar Meningioma

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          Abstract

          Unilateral suprasellar meningiomas have distinct features compared to other midline tumors, as they may produce severe visual symptoms even if small due to an early involvement of the optic canal. Surgical treatment of these tumors from an ipsilateral approach is challenging, as the tumor is covered by the optic nerve that needs to be mobilized to access the optic canal extension. A contralateral approach allows a direct line of sight to the tumor despite a longer working distance. We report the case of a 49-year-old patient presenting with unilateral visual loss related to a left suprasellar meningioma extending to the left optic canal and displacing the optic nerve laterally. Through a right eyebrow approach, a 2.5/2 cm supraorbital bone flap was raised and the orbital floor was thoroughly flattened. After dural opening, the carotid cistern was opened and CSF evacuated allowing a surgery without fixed retractors. The intracranial part of the tumor was removed, but the optic nerve seemed to be still displaced by the intracanalicular part. Under copious irrigation, the medial part of the optic canal was drilled, the dura incised, and the tumor removed. Postoperative course was favorable and the patient made a complete visual recovery. Postoperative MRI showed complete removal of the tumor. We present different surgical steps and discuss the nuances of the procedure. The contralateral eyebrow approach is an interesting addition to the surgical armamentarium and should be discussed for unilateral suprasellar tumors.

          The link to the video can be found at: https://youtu.be/2LTEOaGoKzo .

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          Author and article information

          Journal
          J Neurol Surg B Skull Base
          J Neurol Surg B Skull Base
          10.1055/s-00000181
          Journal of Neurological Surgery. Part B, Skull Base
          Georg Thieme Verlag KG (Stuttgart · New York )
          2193-6331
          2193-634X
          February 2018
          19 January 2018
          : 79
          : Suppl 2
          : S215-S217
          Affiliations
          [1 ]Department of Neurosurgery, Foch Hospital, Suresnes, France
          Author notes
          Address for correspondence Sorin Aldea, MD Department of Neurosurgery, Foch Hospital 40 rue Worth, 92150 SuresnesFrance s.aldea@ 123456hopital-foch.org
          Article
          170140ov
          10.1055/s-0038-1623520
          5796915
          29404257
          1d85b433-5974-4cbd-b2df-01064c4c8edb

          This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

          History
          : 12 October 2017
          : 07 December 2017
          Categories
          Skull Base: Operative Videos

          suprasellar tumor,eyebrow approach,contralateral approach,meningioma

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