Case Report: Supraorbital keyhole resection of IDH-mutant grade 3 astrocytoma of the medial orbitofrontal region

Background: High-grade gliomas located in the medial orbitofrontal region present significant surgical challenges due to their deep location and proximity to critical neurovascular structures. While the supraorbital eyebrow approach is widely used for extra-axial skull base lesions, its application to intra-axial high-grade gliomas remains less frequently reported. Case description: We report the case of a 47-year-old female diagnosed with an isocitrate dehydrogenase (IDH)-mutant World Health Organization Grade 3 astrocytoma located in the medial orbitofrontal cortex. The patient underwent gross total resection via a minimally invasive supraorbital trans-eyebrow craniotomy. Early postoperative MRI performed within 72 hours confirmed gross total resection without residual contrast-enhancing tumor. Histopathological examination demonstrated microvascular proliferation consistent with Grade 3 astrocytoma, and molecular analysis confirmed IDH mutation. The patient subsequently received standard adjuvant radiochemotherapy with temozolomide. Follow-up demonstrated preserved neurological function and high cosmetic satisfaction. Conclusion: This case illustrates that, in carefully selected patients, the supraorbital keyhole approach can achieve oncologically adequate resection of medial orbitofrontal IDH-mutant high-grade gliomas while minimizing surgical morbidity and optimizing cosmetic outcomes.