Bilateral Traumatic Frontal Hematoma Evacuation Using the Supraorbital Keyhole Approach: A Case Report Elucidating Surgical Technique

Bilateral frontal contusions following traumatic brain injury represent a neurosurgical emergency due to their association with intracranial hypertension and risk of herniation. Traditional craniotomies, although effective, often involve significant surgical trauma, prolonged recovery, and less favorable cosmetic outcomes. The supraorbital keyhole approach (SOKA) has emerged as a minimally invasive alternative, particularly for anterior cranial fossa lesions, but its use in extensive bilateral hematomas remains scarcely documented. We present the case of a 36-year-old man with bilateral frontal intraparenchymal hematomas who underwent hematoma evacuation via bilateral supraorbital craniotomies through eyebrow incisions. The procedure allowed near-total evacuation without significant retraction or neurovascular injury. Postoperative recovery was uneventful, with resolution of intracranial hypertension and favorable neurological and aesthetic outcomes. This case demonstrates the feasibility and safety of the bilateral SOKA for traumatic hematomas, suggesting its potential role as an alternative to traditional craniotomies in selected neurotrauma cases.