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Background Skull base tumors, such as large olfactory groove meningiomas (OGMs), are a challenge for neurosurgeons. However, the tendency to reduce invasive surgeries is gaining more adepts. We describe a minimally invasive interhemispheric approach with a falx window for microsurgical resection of the giant OGM as a technical note. Methods A minimal medial frontal craniotomy measuring 3−5 cm in size is performed, and an interhemispheric approach is combined with an opening in the falx to improve microsurgical resection of the giant OGM. The technique and more details are described. Results A minimally invasive interhemispheric approach with a falx window was performed in this case. Gross total resection of the OGM was possible with minimal brain retraction. Simpson grade I was achieved, and there was a good outcome on the postoperative recovery period of the patient, with vision improvement, preservation of olfaction, and no other complications. Conclusions The minimally invasive interhemispheric approach with a falx window is effective and safe for giant OGM with a good outcome for the patient. The opening in the falx improves the interhemispheric pathway and allows gross total resection with minimal brain retraction and low morbidity. [ABSTRACT FROM AUTHOR]

Introduction Preservation of the temporal branches of the facial nerve during anterolateral craniotomies is important. Damaging it can inflict undesirable cosmetic defects to the patient. The supraorbital trans-eyebrow approach (SOTE) is a versatile keyhole craniotomy but still has a high rate of frontalis muscle (FM) palsy. Objective Anatomical study to implement the interfascial dissection during the SOTE to preserve the nerves to the FM. Methods Slight modification of the standard technique of the SOTE was performed in 6 cadaveric specimens (12 sides). Results Distal rami to the FMwere exposed. The standard "U-shape" incision of the FM can cross over the nerves. Alternatively, an "L-shape" incision was performed until the superior temporal line (STL). An interfascial dissection was performed near to the STL and the interfascial fat pad was used as a protective layer for the nerves. Conclusion Various pathologies can be addressed with the SOTE. In themajority of the cases the cosmetic results are good, but FM palsy remains a drawback of this approach. The interfascial dissection may be used in an attempt to prevent frontalis rami palsy. [ABSTRACT FROM AUTHOR]