Endoscopic supraorbital eyebrow approach versus microscopic subfrontal approach for anterior cranial fossa tumor excision: A comparative study of surgical outcome and quality of life

Abstract

Objective: To compare surgical outcomes and quality of life following the endoscopic supraorbital eyebrow approach (ESOA) versus the microscopic subfrontal approach (MSFA) for anterior cranial fossa (ACF) tumor excision.

Methodology: This retrospective comparative study analyzed 48 patients (24 per group) who underwent ACF tumor excision at the Department of Neurosurgery, Unit-III, Punjab Institute of Neurosciences between 2022 and 2024. A total of 48 patients meeting the inclusion criteria were enrolled based on convenience sampling. Patient demographics, tumor characteristics, surgical parameters, complications, and quality of life outcomes were compared between groups using appropriate statistical tests.

Results: Both groups had comparable demographics, tumor sizes, and pathology distributions (predominantly meningiomas). ESOA procedures demonstrated significantly shorter operative durations (226±54 vs. 323±72 minutes, p<0.001), reduced blood loss (219.6±72 vs. 459.2±160 mL, p<0.001), and decreased hospital stays (6.6±3.2 vs. 11.6±5.1 days, p<0.001). Gross total resection rates were similar between groups (ESOA: 50.0% (12) vs. MSFA: 45.8% (11), p=0.78). While CSF leak and wound infection rates were lower in the ESOA group, only the difference in supraorbital numbness reached statistical significance (ESOA: 95.8%(23) vs. MSFA: 50.0%(12), p<0.001). Quality of life scores were significantly higher in ESOA patients (ASBQ score: 82.0±10.2 vs. 63.6±12.4, p<0.001), with better performance in social activities, reduced pain, and faster return to routine activities. Tumor recurrence rates were comparable during the 14-month median follow-up period.

Conclusion: The endoscopic supraorbital approach enhances surgical efficiency, minimizes invasiveness, shortens hospital stay, and improves quality of life, offering comparable resection outcomes and serving as a viable option with careful patient selection.