Jho Institute for Minimally Invasive Neurosurgery Department of Neuroendoscopy
Spine Diseases
     Brain Diseases
        neuralgia

Aneurysm, Cerebral Aneurysm, Cranial Surgery, Dr. Jho's Eyebrow Incision Cerebral Aneurysm Surgery

Dr. Jho's "Band-Aid" Eyebrow Incision Skull Base Surgery for Cerebral Aneurysm, Minimally Invasive Brain surgery

Professor & Chair,  Department of Neuroendoscopy
Jho Institute for Minimally Invasive Neurosurgery

     "Band-Aid" skull base brain surgery for cerebral aneurysms has been developed for minimally invasive cerebral aneurysm surgery.  The small surgical skin incision follows the contour of the eyebrow.  A tiny skull opening is made for exposure at the skull base where the cerebral aneurysm is located.  After a surgical aneurysm clip is successfully placed at the neck of the aneurysm sac, the surgical opening is closed cosmetically.  Metallic brain retractors are not used during surgery in order to avoid unwanted brain damage.
Facts About This Surgery
This method is minimally invasive because it utilizes a smaller hole in the bone as well as a smaller incision than conventional methods.
This technique is innovative because it does not require the use of brain retractors, minimizing the risk of brain damage.
The approach does not sacrifice exposure or outcome by being less invasive.
This procedure provides an alternative to the conventional procedures that often utilize extensive bone and skin flaps.

Discussion
     Utilizing a small hole in the skull above and to the side of the eyebrow, this minimally invasive skull base procedure provides a direct "shortcut" approach to tumors and aneurysms.  Nicknamed "Band-Aid" surgery because only a "Band-Aid" type of small bandage is needed to cover the postoperative incision, this surgery does not sacrifice exposure for the surgeon while providing the many benefits of being less invasive.  Cerebral aneurysms can be reached through a two-inch skin incision and a small bone hole called a craniotomy.  This technique is referred to as a superolateral craniotomy because the approach is above the eye and slightly to the side.  Brain retractors are not used, which reduces the risk of brain injury.  Positive feedback has been received concerning the cosmetic healing of the small incision.

A:     B:      C:
Figure 1. A preoperative cerebral arteriogram (A) shows a basilar tip aneurysm.  A postoperative arteriogram, after aneurysm clipping via a superolateral orbital craniotomy, confirms successful clipping (B). A patient with a healed superolateral orbital craniotomy incision line (C) (arrows).

Reference
Jho HD: Superolateral orbital approach via a lateral eyebrow incision as a simplified skull base approach. In Rengachary SS, Wilkins RJ (eds), Neurosurgical Operative Color Atlas, Williams and Wilkins (in press)


For referral information or appointment for consultation contact:
                            Practice Manager:  Robin A. Coret
              e-mail : rcoret@drjho.com
                                       Tel : (412) 359-6110
                                     Fax : (412) 359-8339

         Address : JHO Institute for Minimally Invasive Neurosurgery
                            Department of Neuroendoscopy
                               Sixth Floor, South Tower
                               Allegheny General Hospital
                               320 East North Avenue
                               Pittsburgh, PA 15212-4772
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