Clinical Analysis Of Supraorbital Keyhole Approach Via A Forehead Wrinkle Incision For Resection Of Tumors In Anterior Skull Base And Sellar Region

Objective To investigate the clinical effect of supraorbital keyhole approach via a forehead wrinkle incision in resection of tumors in anterior skull base and sellar region.Methods From January 2017 to February 2020,the clinical data of 60 patients with tumors located in anterior skull base and sellar region who underwent surgery through supraorbital keyhole approach via a forehead wrinkle incision in Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.All patients underwent MRI plain scan and enhanced scan before operation,including 47 cases of meningioma（including 23 cases of olfactory groove meningioma,17 cases of tuberculum sellae meningioma and 7 cases of sphenoid ridge meningioma）,8 cases of craniopharyngioma and 5 cases of pituitary adenoma.According to the size and growth of tumor,skin incision and bone flap position were designed individually.Postoperative imaging data and clinical symptoms were used to evaluate the total resection rate and the incidence of complications,and the satisfaction of patients with regard to the aesthetic of forehead wrinkle incision was investigated.The tumor recurrence rate and survival rate were followed up 12 months after operation.Result Among the 60 patients in this group,53 patients achieved total tumor resection（88.3%）,of which the total resection rate of meningioma was 97,8%（46 / 47）;Near-total resection was achieved in 7 cases（11.7%）.There were no cases of death directly caused by surgery.The pathological results of this group of cases were confirmed to be consistent with the preoperative imaging diagnosis after operation:3olfactory groove meningioma,17 tuberculum sellae meningioma,7 sphenoid ridge meningioma,8 craniopharyngiomas and 5 pituitary adenoma.The questionnaire on incision pain showed that 54 patients（90.0%）had a score of 1（extremely mild pain）,and only one patient had a maximum score of 3,indicating that the pain was obvious.The overall satisfaction rate（score less than 3）was 98.3%.The questionnaire of satisfaction of patients with regard to the aesthetic of forehead wrinkle incision showed that 55 patients（91.7%）scored 1 point,which represented that they were extremely satisfied with the aesthetic of incision,and only 2 patients scored the highest score of 3points,indicating that they were not very satisfied with the healing of incision 3 months after operation.The overall satisfaction rate（score less than 3）was 96.7%.Transient diabetes insipidus occurred in 4 patients（3 pituitary adenomas and 1craniopharyngioma）and three patients had short-term electrolyte disorder（1 pituitary adenoma and 2 craniopharyngioma）which all returned to normal after symptomatic treatment.Subcutaneous effusion occurred in 2 patients after operation,which disappeared after puncture,suction and pressure bandage.There were no cases of disappearance of forehead wrinkle or eyebrow lifting disorder,indicating that the frontal branch of facial nerve was protected effectively.The median follow-up time of was 18.0± 5.6 months（1-36 months）after operation.The survival rate was 100% and no death occurred during follow-up period.All patients’ preoperative symptoms were cured or improved.Among them,6 patients had forehead numbness or supraorbital hypoesthesia after operation.During the follow-up of 3 months after operation,the symptoms disappeared or improved.Among the 60 patients,2 cases of pituitary adenoma recurred one year after operation,and there was no recurrence after reoperation during rehospitalization.Conclusions In conclusion,supraorbital keyhole approach via a forehead wrinkle incision is more suitable for tumors near the midline of the anterior skull base and sellarregion.It has good indications for olfactory groove meningioma,tuberculum sellae meningioma,sphenoid ridge meningioma,pituitary adenoma and craniopharyngioma.It has no significant difference in exposure and total resection rate from the traditional surgical approach,In addition,the visual field range and operation angle of the expanded supraorbital keyhole approach are significantly improved,and a certain surgical incision method can effectively avoid complications of temporal muscle or supraorbital nerve.When combined with neuroendoscopy,its visual field range and operation effect can be further improved.However,the supraorbital keyhole approach also has its own shortcomings and limitations.We also need to select patients individually and and chose the surgical indications strictly in order to achieve satisfactory surgical results.