Brain tumours removed
through eyebrow incision

The eyebrow—and a small section of the bone behind it—has become the latest point of entry in reaching and removing brain tumours. By making an incision in the eyebrow and removing a bit of bone from the skull, Dr. Salvatore Di Maio, a cerebrovascular and skull base neurosurgeon at the JGH, can gain access, in some cases, to tumours of the skull base without using more extensive surgical approaches. This enables patients to recover more quickly, with little cosmetic change to their post-surgical appearance.

Dr. Salvatore Di Maio

Dr. Di Maio says the procedure—known as an eyebrow supra-orbital craniotomy—was first proposed in the late 1990s, but began to gain broader acceptance only in the last decade. Even now, it tends to be done in select higher-volume centres, making the JGH one of the few Canadian hospitals where this type of minimally invasive surgery is an option, in addition to endoscopic and open skull-base surgery.

Since 2011, Dr. Di Maio has also been collaborating with Dr. Marc Tewfik, a JGH ear-nose-and-throat sinus surgeon, on another minimally invasive procedure in which small-scale instruments are inserted into the nostrils and through the nasal cavities to reach tumours of the brain or pituitary gland.

However, through-the-nose surgery may not always be a practical way of reaching tumours in the front part of the brain and base of the skull. In these instances, Dr. Di Maio says, the path to the tumour may be blocked by the optic nerves or the carotid arteries.

The solution is the eyebrow supra-orbital craniotomy. After an incision is made in the eyebrow, a piece of bone—about 2½ centimetres in diameter—is removed. Afterwards, the bone is replaced and held in position with tiny titanium plates, and the eyebrow is sutured.

Click to enlarge

“Of course, where circumstances demand it, we still perform open surgery to the skull base,” Dr. Di Maio says. “But it’s encouraging that we now have another minimally invasive option that, in some cases, permits patient recovery to occur more quickly.”

By attracting and retaining the world’s top professionals, the JGH can provide the most advanced medical and surgical expertise in all specialties. The recruitment of healthcare leaders, such as Dr. Di Maio, has been achieved through private support, as has the purchase of specialized equipment—for example, dedicated endoscopic equipment, image guidance systems and powered instruments. For more information or to make a donation, please contact the JGH Foundation.