Outcomes of the Supraorbital Approach for Intra-Axial Lesions: A Retrospective Series

Introduction: The supraorbital (SO) craniotomy is a keyhole approach widely used for extra-axial pathologies. Its role for intra-axial pathology is less characterized. We report a single-center experience examining feasibility, extent of resection, and perioperative morbidity using SO for intra-axial lesions. Methods: Retrospective review of SO craniotomies for intra-axial lesions at our institute between 2014–2025. Demographics, pathology, lesion size, operative metrics, complications, disposition, and radiographically determined extent of resection were abstracted. Results: Nine patients (mean age 59.1 ± 19.5 years; 4 male) underwent SO craniotomy for intra-axial pathology. All lesions were frontal lobe; mean maximum diameter 4.0 ± 1.4 cm (1.8–6.0). Pathologies: metastases (n=4), gliomas (n=3), ependymoma (n=1), abscess (n=1). Mean operative time 259.4 ± 95.6 min (170–440); estimated blood loss 56.7 ± 58.6 mL (10–200). Stereotactic navigation used in all cases; microscope in 7/9 (77.8%). No 30-day mortalities, perioperative strokes, surgical-site infections, or CSF leaks. Minor approach-related complications: ptosis (1/9), transient frontalis weakness (1/9), mild frontalis weakness (2/9), transient forehead numbness (1/9), mild forehead numbness (2/9). Gross total resection (GTR) in 5/8 (62.5%) and near total resection in 3/8 (37.5%) tumor cases; the abscess was drained, irrigated, and debrided. Disposition: 7/9 (77.8%) discharged home; 2/9 to inpatient rehabilitation. Modified Rankin score of 1.6 ± 1.5 (0–4) at discharge. Conclusion: In carefully selected frontal intra-axial lesions, the SO craniotomy provided effective access with high GTR rates and low morbidity in this series. These findings support the SO approach as a viable minimally invasive corridor for intra-axial lesions and justify larger studies to define indications and limits. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany