Brain Surgery Through Eyelid

To perform brain surgery, doctors need to make an incision into the scalp then remove a piece of the skull (or drill a hole) to access the target area of the brain. Now some surgeons are accessing the brain through a unique method – by going through the crease of the eyelid. Khaled Aziz, M.D., Ph.D, a Neurosurgeon at Allegheny General Hospital in Pittsburgh, helped pioneer the method.

Aziz says eyelid access is done in conjunction with an ocular plastic surgeon. The plastic surgeon makes the incision into the eyelid. Next, Aziz takes over, carefully separating the tissue under the eyelid and exposing the skull. A small section of bone is removed to access the brain. Then, using surgical microscopes and tiny instruments, he takes out the tumor in pieces or repairs the aneurysm. The surgical instruments are withdrawn and the bone in the skull is replaced or repaired with bone cement, titanium plates and/or screws.

The eyelid approach is much less invasive than traditional surgery, which uses a long incision under the hairline. Doctors avoid cutting through muscles at the top of the head and patients have less pain. Aziz says patients experience a significant amount of eyelid swelling for a few weeks, but the symptoms can be controlled with ice packs. In most patients, the signs of surgery are nearly invisible within four weeks.

According to Aziz, the eyelid approach can be used for patients with tumors, aneurysms or cysts in the front part of the brain. He cautions patients before surgery that if problems occur or if the target is not accessible through the eyelid, he will need to revert back to the traditional open surgery. So far, he has used the eyelid technique on fewer than 20 patients. He believes he is one of only two surgeons in the U.S. using the eyelid approach.

AUDIENCE INQUIRY
For information on brain aneurysms:
The Brain Aneurysm Foundation, http://www.bafound.org
National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov