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S123: TRANSFRONTAL SINUS APPROACH USING A "GULL WING" SKIN INCISION AND ASSISTED WITH SYNCHRONIZED AUGMENTED REALITY PLATFORM: A CASE SERIES
Franco Rubino, MD¹; Peter Harris, MD²; Randolph Wojcik, MD³; Walter C Jean, MD⁴; ¹Baptist Health Medical Center; ²George Washington University; ³Lehigh Valley Health Network; ⁴University Of South Florida

Introduction: The transfrontal sinus (TFS) approach is a neurosurgical technique used to access lesions located in the anterior skull base, particularly those involving the frontal lobe or the parasellar region.  The most common incision used is a coronal incision. The gull wing incision is named for its distinctive shape, which resembles a bird's wings in flight. This study aimed to describe a neurosurgeon experience with this incision, including decision-making criteria and lessons learned.

Methods: This retrospective case series analyzed 8 consecutive patients treated with TFS craniotomy using the Gull-wing skin incision.  Surgical rehearsal in virtual reality (VR) was generated to ensure precise surgical openings. The optimal openings were saved and, at surgery, projected into the eyepiece of the navigation-tracked microscope (Figure 1). 

Results: We performed the transglabellar approach in eight patients with anterior skull base meningiomas. Two-thirds were female (n=5), with a mean age of 63.3 ± 15.5 years. Frontal sinus pneumatization was present in 75% (n=6), with mean dimensions of 5.3 cm (side-to-side) and 1.1 cm (anteroposterior). The average craniotomy size was 6.4 cm² (range: 2.9–16.2). Gross total resection was achieved in 87.5% (n=7), with one subtotal resection due to tumor extension (Figure 2). Mean tumor volume was 12.4 ± 15.1 cm³, and 75% were under 10 cm³. Operative time averaged 333.6 minutes (range: 210–604), and hospital stay averaged 3.3 days (range: 1–7). Complications included one surgical site infection, one transient fluid collection, and one CSF leak requiring endonasal repair. All patients were satisfied with cosmetic outcomes at follow-up (Figure 3 and Table 1).

Conclusions: The gull-wing incision for TFS craniotomy is a promising technique that provides effective access to complex anterior skull base lesions, combining innovative surgical planning with favorable patient outcomes. Further studies may enhance our understanding of the technique's benefits and limitations, optimizing its application in neurosurgical practice.

FIGURE 1

FIGURE 2

FIGURE 3

TABLE 1

 

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