First Indian Series on Trans Eyelid Mini Supraorbital Approach for Anterior Skull Base Lesions (TEMSA): A Keyhole Minimally Invasive Neurosurgical Approach.

Abstract:

Background: The surgical management of anterior skull base lesions inherit challenges due to their proximity to critical neurovascular structures and complex anatomy. Traditional approaches, including lateral subfrontal, pterional and endoscopic techniques, though effective, are associated with approach related morbidity and prolonged recovery. The Trans Eyelid Mini Supraorbital Approach (TEMSA), a novel minimally invasive technique, has emerged as a promising alternative, aiming to optimize patient outcomes with minimal surgical morbidity. However, the literature on this is sparse compared to other approaches.

Methodology: This study, one of the first from India,  presents a case series of 15 patients treated  by single surgeon with TEMSA for anterior skull base lesions between March 2018 and September 2023. Inclusion criteria encompassed a range of lesions with suitability for TEMSA, as assessed through preoperative evaluations including MRI, CT, and angiography. The TEMSA procedure involved a transcutaneous eyelid incision, followed by a small supraorbital craniotomy. Data on demographics, lesion characteristics, surgical details, and outcomes were prospectively collected and analyzed.

Results: The patient cohort included a variety of skull base lesions, primarily meningiomas, gliomas and  and unruptured aneurysms. The surgical objective was achieved in 100% of cases, none requiring revision surgery due to inadequate exposure. Complete resection was achieved in 80% of cases with tumours, with a mean surgical duration of 180 minutes  (range = 120-250 minutes)  and blood loss of 100 ml (Range 50 – 300 ml) , respectively. Approach-related complications were mild, minimal and transient, affecting only 3 patients. There was only a single patient with mild frontal lobe contusion who was on blood thinners.  This patient was asymptomatic and needed no intervention.  All patients reported excellent to good cosmetic outcomes, and the hospital stay ranging from 36 hours to 5 days. No recurrences were observed in complete resection cases over a median 12-month follow-up.

Conclusions: TEMSA represents a significant and a more efficient alternative in the minimally invasive treatment of anterior skull base lesions. The approach is associated with satisfactory rates of completeness of resection, minimal approach related complications, excellent cosmetic outcomes and witnessed enhanced recovery. Further studies with larger sample sizes are warranted to validate these findings and explore long-term outcomes.

Keywords: Anterior skull base, Keyhole Surgery, Trans eyelid, Supra orbital, Transpalpebral, Minimally Invasive