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Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes

Yang, Chen Yi and Faung, Brian and Patel, Neal A. and Brown, Nolan J. and Gendreau, Julian L. and Lien, Brian V. and Shahrestani, Shane and Choi, Ashley E. and Ong, Vera and Loya, Joshua (2022) Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes. World Neurosurgery, 164 . pp. 70-78. ISSN 1878-8750. doi:10.1016/j.wneu.2022.04.094.

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Background: Supraorbital keyhole craniotomy is a minimally invasive approach used to access the parasellar region with advantages of decreased cortical exposure, simple closure, and decreased risk of postoperative cerebrospinal fluid leak. The incision of this approach, however, has raised cosmetic concerns, especially for pediatric patients. The aim of this study is to assess postoperative complications and cosmeses of the supraorbital keyhole approach for resection of intracranial lesions in pediatric patients. Methods: A literature search of PubMed, Scopus, and Web of Science databases was performed on June 1, 2021, searching for all studies of pediatric patients undergoing supraorbital keyhole craniotomy for surgical resection of lesions in the anterior fossa/sellar region. Results: Of 729 unique hits, 15 supraorbital keyhole studies reporting on 177 pediatric cases were included in the final review. Quality of all included studies was moderate. Overall, the surgery was well tolerated with a low number of severe adverse events. A wide variety of pathologies were treated with this approach. Complications of surgery included changes in vision, epidural hematoma, subdural hematoma, cerebrospinal fluid leak, and wound infection. At 6 weeks of follow-up, surgical scars in most patients were noted to be minimally detectable. At 3–6 months of follow-up, scars were no longer visible. Cosmetic complications included 5 bone defects, 1 split eyebrow, and 1 case of ptosis. Conclusions: This study suggests that supraorbital keyhole craniotomy is a safe and effective approach to access the parasellar region in pediatric patients with excellent cosmetic outcomes reported across multiple institutions.

Item Type:Article
Related URLs:
URLURL TypeDescription
Yang, Chen Yi0000-0002-5547-3150
Patel, Neal A.0000-0003-4992-1356
Brown, Nolan J.0000-0002-6025-346X
Gendreau, Julian L.0000-0001-8412-0437
Lien, Brian V.0000-0003-3044-8626
Shahrestani, Shane0000-0001-7561-4590
Ong, Vera0000-0003-0522-7493
Loya, Joshua0000-0002-0852-0014
Additional Information:© 2022 Elsevier Inc. Received 15 March 2022, Accepted 23 April 2022, Available online 28 April 2022. The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Chen Yi Yang, Brian Faung, and Neal A. Patel are co–first authors.
Subject Keywords:Cosmetic; Cranial; Craniotomy; Keyhole; Neurosurgery; Pediatric; Supraorbital
Record Number:CaltechAUTHORS:20220517-424848000
Persistent URL:
Official Citation:Chen Yi Yang, Brian Faung, Neal A. Patel, Nolan J. Brown, Julian L. Gendreau, Brian V. Lien, Shane Shahrestani, Ashley E. Choi, Vera Ong, Joshua Loya, Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes, World Neurosurgery, Volume 164, 2022, Pages 70-78, ISSN 1878-8750,
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:114774
Deposited By: George Porter
Deposited On:18 May 2022 14:58
Last Modified:24 May 2022 18:17

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