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The transpalpebral incision: its use in keyhole approaches to cranial base brain tumors

The push in modern neurosurgery has been for the development of minimally invasive approaches for cranial base lesions, as an alternative to the larger, more complex skull base approaches. The introduction of endonasal endoscopic approaches provided a minimally traumatic approach to lesions in the midline skull base from the cribiform plate to the sella and clivus. The keyhole craniotomies, such as the supraorbital craniotomy, have provided a similar solution for select lesions in all three cranial fossae. Concurrently, with an improved appreciation on postoperative wound healing and cosmesis, the current trend is to also take advantage of natural orifices (endonasal techniques) and skin creases. The transpalpebral incision – borrowed from ocular plastics – has been paired with the supraorbital craniotomy as a keyhole approach. In this brief article, we discuss current trends in minimally invasive approaches and considerations in using the transpalpebral approach for a variety of tumors.