Supraciliary keyhole craniotomy for brain abscess debridement

Object. Treatments for brain abscesses have typically involved invasive craniotomies followed by debridement. These methods often require large incisions with vast exposure and may be associated with high morbidity rates. For supraorbital lesions of the anterior and middle cranial fossa, minimally invasive craniotomies may limit exposure and decrease surgically related morbidity while allowing adequate debridement and decompression. The authors report their experience in treating frontal epidural abscesses in pediatric patients through minimally invasive supraciliary craniotomies over a 4-year period. Methods. Three pediatric patients with frontal epidural abscesses underwent minimally invasive debridement procedures. Each procedure consisted of a supraciliary incision and a small craniotomy to expose the abscess. All patients underwent pre- and postoperative radiological evaluation including computed tomography and magnetic resonance imaging. Data were collected on preoperative characteristics, operative management, and postoperative outcomes. Results. Two patients were male and 1 patient was female. The ages of the patients ranged from 6 to 10 years (mean 8 years). A frontal abscess was diagnosed in all patients, and all were treated surgically without perioperative complications. Microbes cultured postoperatively included methicillin-resistant Staphylococcus aureus in 2 patients and Staphylococcus viridans in 1 patient. The mean follow-up duration was 12.3 months. No neurological or vascular complications were noted during follow-up. All patients were treated with antibiotics postoperatively and experienced resolution of symptoms and excellent outcomes. Conclusions. Frontal epidural abscesses can be adequately and safely debrided via a minimally invasive supraciliary craniotomy. This approach has a cosmetic benefit and may decrease approach-related morbidity.