Supraorbital Transciliary Approach For Management Of Intracranial Skull Base Lesions: 2 Years Of Experience In Cote D’ivoire

Abstract

Background: The supraorbital transciliary technique is a minimally invasive approach that provides a direct corridor to the anterior, middle and part of the posterior skull base (SB). In the early 1900s, F Krause initiated the subfrontal unicoronal approach, later modified with a minimal incision through the eyebrow by E. Van Lindert et al. in 1998. This study sets out to evaluate a 2 years’ experience using this technique in Cote d'Ivoire. Methods: Technique: Patients in supine position underwent a minutious unilateral or bilateral transciliary incision, 1cm away from supraorbital notch, followed by craniotomy and dural opening. Dissection was performed with a microscope, image guidance or endoscope. Population: 23 patients with skull base lesions were operated using this approach between December 2020 and August 2022. Results: We had 14 tumours amongst which 11 cases of meningioma; (04) planum sphenoidal, (02) tuberculum sellae, (02) Olfactory groove, (03) anterior clinoid process, 1 case of mucinous carcinoma extending from the frontal sinus to the anterior skull base, 1 case of pituitary macroadenoma and 9 posttraumatic anterior SB CSF leak. The average tumoral size was 59.87±35,2mm. In 12 out of 14 patients, gross total resection was achieved with a mean operative time of 4.1 hours and an average hospital stay of 5.2. The cosmetic outcome was quite pleasant. We had 2 operatory site infections. Conclusion: The supraorbital transciliary approach for SB lesions has shown to be a satisfactory experience in Cote d'Ivoire for both the surgeon and the patient. This approach reduces tissue trauma, providing shorter operating and hospitalisation times while equaling or even exceeding conventional approaches' safety and efficacy profiles.