2026 Poster Presentations
P318: SUPRAORBITAL KEYHOLE APPROACH: OUR EXPERIENCE WITH A MINIMALLY INVASIVE NEUROSURGICAL TECHNIQUE
Mario Chiapponi, MD1; Denis Aiudi, MD1; Valentina Liverotti, MD1; Ruggero Antonini, MD1; Sanad Elshiky, MD2; Celeste Casali, MD1; Damiano Giovine, MD1; Maurizio Iacoangeli, Prof, MD1; 1Departement of Neurosurgery, Marche University Hospital, Ancona, Italy; 2Department of Neurosurgery, Al-Galaa Trauma Hospital, Benghazi, Libya
Introduction: The Supraorbital Keyhole Approach (SKA) is a minimally invasive surgical technique designed to minimize soft tissue trauma and reduce cerebral retraction while ensuring oncological radicality in the management of anterior cranial base and sellar/suprasellar tumors. Unlike traditional craniotomies such as the pterional or orbitozygomatic approaches, the SKA employs a limited transciliary or eyebrow skin incision and a focused supraorbital craniotomy to create a subfrontal corridor. This keyhole approach facilitates access to selected skull base lesions with reduced morbidity and comparable therapeutic efficacy. Current literature supports its growing adoption as a safe and effective alternative to standard approaches for appropriately selected cases.
Materials and Methods: We retrospectively analyzed a monocentric cohort of 32 adult patients who underwent SKA for intracranial neoplasms at the Neurosurgery Clinic of Ancona between January 2018 and August 2025. Parameters evaluated included clinical presentation, radiological findings, histopathological diagnoses, laboratory data, and intraoperative technical details. All patients had at least one month of clinical and radiological follow-up.
Results: The median patient age was 55 years. The histopathological spectrum comprised 21 (65.6%) anterior cranial base meningiomas (including 3 atypical), 8 (25%) sellar/suprasellar lesions (4 pituitary adenomas, 3 craniopharyngiomas), and 3 (9.4%) intra-axial frontal tumors (3 glioblastomas, 1 oligodendroglioma). Gross total resection (GTR) was achieved in 84.4% (27/32) of cases, with Simpson grade I–II resection attained in 81% of meningiomas. Visual deficits present preoperatively (n=15) improved in 66.7% and stabilized in 33.3%, with no aggravations. Complications at 30 days included cerebrospinal fluid leakage in 3.1%, transient supraorbital hypoesthesia in 6.3%, transient frontalis branch paresis in 3.1%, and surgical site infection in 3.1%. No unplanned reoperations were necessary, although one patient required a planned endoscopic endonasal procedure for residual tumor. There was no perioperative mortality, and median hospital stay was 4 days.
Conclusions: Our experience confirms that the Supraorbital Keyhole Approach is a safe and efficacious minimally invasive option for resection of selected anterior skull base and sellar region tumors. The technique offers oncologically sound resection rates with low morbidity, rapid postoperative recovery, and favorable functional outcomes, including visual preservation. Meticulous dural closure with duraplasty and sealants is integral to minimizing CSF leak rates. SKA constitutes a valuable alternative to traditional craniotomies in appropriately selected patients.