• da Costa Marcos Devanir Silva MDS Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil. Electronic address: marcoscostaneuro@gmail.com., Douglas A Hardesty, Blake Priddy, Raywat Noiphithak, Juan Manuel Revuelta Barbero, and Daniel M Prevedello.
• Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil. Electronic address: marcoscostaneuro@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 354-359.

BackgroundThe extended supraorbital approach through a modified eyebrow incision is a minimally invasive variant of the frontotemporal or pterional approach that enriches a neurosurgeon's armamentarium for the treatment of pathologies lateral to the anterior clinoid process, by advancing laterally with frontal facial nerve branches monitoring. To demonstrate the steps of the approach, we studied 2 formalin-fixed and artery/vein silicone-injected adult cadaveric heads, and reviewed 1 of the 3 clinical cases operated on to illustrate the applicability of the approach.Clinical PresentationA 56-year-old woman presented with a history of seizures and a complaint of headache that started 2 months ago. She underwent an examination with brain magnetic resonance imaging that showed a dural-based lesion at the medial third of the lesser wing of sphenoid (which is consistent with meningioma). The patient underwent craniotomy with an extended supraorbital approach through a modified eyebrow incision that allowed Simpson grade II removal to be performed and good aesthetic outcome to be achieved.ConclusionsThe extended supraorbital approach through a modified eyebrow incision is a minimally invasive approach that can add to a neurosurgeon's armamentarium and be used with microscopy, assisted by endoscope, or both to reach the anterior and middle cranial fossae.Copyright © 2019 Elsevier Inc. All rights reserved.

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