Multiple Supraorbital Keyhole Craniotomies Via Eyebrow Incision: Cosmetic and Functional Outcomes

Introduction: The supraorbital keyhole (SO) craniotomy is a minimally invasive approach to pathologies of the anterior cranial fossa, parasellar region, prepontine cistern, and anterior Sylvian fissure. This approach is typically performed through an eyebrow incision. This technique has been previously described, but the impacts of multiple repeat surgeries through an eyebrow incision has not been as extensively reported. Here we report the outcomes of multiple repeats SO craniotomies through a single eyebrow incision. Methods: All patients undergoing SO craniotomies at a single institution were reviewed over a 15-year period from September 2010 to September 2025. Only patients undergoing multiple SO craniotomies through an eyebrow incision were included in the study. Results: During the study period, 77 SO craniotomies were performed on 71 different patients. A total of five patients underwent repeat SO craniotomies with four patients undergoing two craniotomies and one undergoing three. Four of the five patients presented with visual decline prior to the initial and repeat surgeries. All of these patients had improvement in their visual symptoms post-operatively. No patient developed frontalis palsy after a repeat surgery. However, one patient had a frontalis nerve palsy after the initial surgery which resolved within three months of surgery. Forehead numbness was experienced by two patients after repeat surgery but again resolved within three months of surgery. Infection, CSF leak, and pseudomeningocele formation were not seen in any patient in the study cohort. Additionally, all patients had a good cosmetic outcome with no incidence of eyebrow alopecia or hyperpigmentation. Conclusion: Performing repeat SO craniotomies through an eyebrow incision is safe and can lead to good cosmetic and surgical outcomes in patients with recurrent disease of the anterior cranial fossa. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany