Transorbital eyebrow lacrimal keyhole approach for resection of a meningioma of the lateral wall of the cavernous sinus

The transorbital approach has emerged as a minimally invasive technique in neurosurgery. The authors present the case of a meningioma of the lateral wall of the cavernous sinus treated with a transorbital eyebrow lacrimal keyhole approach (TELKA) in a 64-year-old man with partial seizures. By removing the lip of the superolateral orbital rim, the so-called lacrimal keyhole, via an eyebrow incision, optimal microscopic and endoscopic visualization and maneuverability were achieved, avoiding dangerous ocular globe retraction. Together with the chopstick technique using angled endoscopes and malleable rotative suction, TELKA allowed a safe and effective resection minimizing soft tissue dissection, brain manipulation, and ocular retraction.