In just the past sixth months, neurosurgeons have begun to make the switch on a massive scale to conducting tumor-removal by making a supra-orbital incisions rather than going in through the nose. Studies have shown that there is an increased probability of CSF leaks as a result of endonasal procedures, and supra-orbital eyebrow incisions allow for a cleaner way to pull out a tumor in the frontal lobe. The main advantage of going in through the eyebrow, however, is that there is little to no retraction of the frontal lobe involved, unlike in endonasal surgeries.
The risks associated with brain retraction, especially in the frontal lobe, include general brain tissue damage, loss of vision, thrashing incapacitating headaches, and worst of all, perioperative morbidity.
This approach is performed through an incision in the eyebrow and the consequent removal of a tiny piece of skull. It differs from the traditional fronto-temporal craniotomies in that it involves much less bone removal and, as mentioned before, minimal to no brain retraction as shown:
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The patient, who had the operation three months earlier, received chemotherapy just after the surgery. Her chemo lasted for about two months. Cosmetically, the eyebrow looks completely normal. There is a little bit of swelling around the eye that increases and decreases periodically but should completely heal after a year or so. Nevertheless, the damage to the frontal lobe did reduce motion to the side of the face operated on. On that side, the patient could not lift her eyebrow as far as she could on the other. Apparently it is possible for that nerve injury to completely heal, but full recovery of that nerve is not guaranteed. Other than that, however, only good news was buzzing through the clinic. The tumor was gone, the scans showed no signs of regrowth, and the frontal lobe seemed completely healthy as it adopted to the removal of the tumor and grew to fill the cavity.
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