Lesions in the parasellar region and the interpeduncular fossa, including medialthird sphenoid wing meningiomas, petroclival meningiomas, trigeminal neurinomas, and basilar tip aneurysms, are very difficult to approach for radical procedures. The orbitozygomatic approach provides access to the anterior and middle cranial fossae as well as the deep sellar and basilar apex regions. The orbitozygomatic approach oza and extradural temporopolar approach edtpa are standard skull base techniques to access the central skull base from the anterolateral direction. An 80yearold man presented with a severe headache of sudden onset and nausea. The orbitozygomatic access was firstly described by hakuba, in 1986 1, 2 as the result of small changes to the frontotemporosphenoidal craniotomy 3, 4, 5. Schwartz the guiding principle of skull base surgery is the avoidance of brain retraction by the removal of additional bone. This modified technique eliminates the need for bone reconstruction of the orbital. The moz approach starts with a curvilinear skin incision from 1 cm anterosuperior to the tragus and extends superiorly to the.
This patient had an acoa aneurysm with a multilobulated appearance, and the primary lobe projected into the interhemispheric fissure. Dec 25, 2008 the orbitozygomatic approach provides access to the anterior and middle cranial fossae as well as the deep sellar and basilar apex regions. Threepiece orbitozygomatic approach campero a, marins c, socolovsky m, torino r, yasuda a, domitrovic l, rhoton a jr. Orbitozygomatic approach operative neurosurgery oxford. This approach was performed, from 2002 to 2011, in 49 patients admitted at beneficencia portuguesa of sao paulo hospital. This approach is particularly useful for highpositioned, small, anterior projective aneurysms and cases with dilation of the third ventricle due to hydrocephalus or clot. However, few studies have provided a detailed analysis of the technique and surgical landmarks using threedimensional 3d models. Orbitozygomatic approach the orbitozygomatic approach oza, along with the pterional approach, is one of the most versatile anterolateral approaches to the skull base. The transzygomatic approach offers excellent exposure to the floor of the middle fossa and the lateral wall of the cavernous sinus both intradurally and extradurally. Orbitozygomatic approach for bullet retrieval from the. Lateral supraorbital approach vs pterional approach. The approach has been applied effectively to neoplastic and vas.
The orbitozygomatic approach is a modification and extension of the pterional craniotomy to gain a wider exposure of structures at a cranial base. The orbitozygomatic approach oza, along with the pterional approach, is one of the most versatile anterolateral approaches to the skull base. Ince the seminal description of the supraorbital crani otomy by jane, et al. The subcranial approach was combined with a midfacial degloving procedure in 14 patients, medial maxillectomy in, orbitozygomatic approach in 6, transorbital approach in 5, transfacial approach in 2, and le fort i downfracture in 1. The frontotemporalorbitozygomatic ftoz approach, also known as the workhorse of skull base surgery, has captured the interest of many researchers throughout the years. Recent advances in threedimensional 3d technology can be combined with dissections to better understand the spatial. Read orbitozygomatic approach for excisions of orbital tumors with 1 piece of craniotomy bone flap. The orbitozygomatic craniotomy has been developed and modified over the last three decades, and has become a quintessential approach and technique for the wellrounded neurosurgeon. Frontotemporal approach with orbitozygomatic removal. An anatomic qualitative and quantitative evaluation. This allows a wide exposure of the frontoorbital region on the side of the approach.
In order to quantify the gain provided by this enlarged approach, the authors underwent anatomical studies comparing the field view angle of various intracranial targets with and without orbitozygomatic removal, in 11 fresh human. The terms unilateral transbasal and orbitozygomatic infratemporal are synonyms of the term orbitozygomatic. It is a path that neurosurgeons use to approach aneurysms and other lesions in the brain. It is essential for neurosurgical practice to dominate and be familiarized with its multilayer anatomy.
The orbitozygomatic craniotomy is one of the workhorse approaches of skull base surgery, providing wide, multidirectional access to the anterior and middle cranial fossae as well as the basilar apex. The frontotemporalorbitozygomatic ftoz approach is widely used for accessing anterolateral lesions in skull base surgery. The approach that will be used in this surgery is shown by the third arrow that is colored purple this animation shows the mini orbitozygomatic approach. Bilateral frontoorbitozygomatic craniotomya combined. Oz approaches were performed in 3 cadaveric specimens. The miniorbitozygomatic moz approach has been commonly used to treat anterior communicating artery, internal carotid artery bifurcation, and superior cerebellar artery aneurysms. His medical history included the surgical clipping of a ruptured basilar tip aneurysm and unruptured right internal carotidposterior communicating aneurysm through the right orbitozygomatic approach 14 years ago. Orbitozygomatic approach and extradural temporopolar. Combined subcranial approaches for excision of complex. The cisterns were opened sharply via an orbitozygomatic. When a patients head is rotated away from the aneurysm and extended, the superior and lateral orbit becomes the roof of the operative corridor. Many incisions have been described for approaches to orbitozygomatic fractures, the most frequently used being the subciliary incision with its modifications, the subtarsal incision, and the transconjunctival incision with or without lateral canthotomy. Cureus immersive surgical anatomy of the frontotemporal. Threepiece orbitozygomatic approach alvaro campero.
Dissections were carried out in a stepwise fashion and recorded in stereo pictures. This approach avoided the need for a direct incision, which avoided potential. In 2002, after the original description by jane et al 16 and almefty, 7 abdel aziz et al 6 redefined the 1piece orbitozygomatic approach. The various methods to perform the orbitozygomatic approach were examined in this study. The orbitozygomaticcombined supra and infratentorial. Nov 11, 2017 an outline of the osteotomies for 2piece orbitozygomatic approach. The orbitozygomatic approach is a modification and extension of the pterional craniotomy to gain a wider exposure of structures at a crania we use cookies to enhance your experience on our website. In many cases, however, only a portion of the exposure provided by the full orbitozygomatic approach is needed. The orbitozygomatic oz approach is an extension of the basic frontotemporal ft approach, which is associated with an oz osteotomy and eventually with zygomatic arch resection. Working area and angle of attack in three cranial base. The cisterns were opened sharply via an orbitozygomatic approach to permit proximal, distal, and neck control. Many studies have described the technique and quantified the surgical exposure and freedom provided by the ftoz approach. The orbitozygomatic approach is a useful method for managing. An outline of the osteotomies for 2piece orbitozygomatic approach.
Discuss the advantages of the subtarsal approach versus the subciliary approach. However, few studies have described reconstructive techniques or functional and cosmetic outcomes. It exposes transylvian and lateral subfrontal views 8, 9 in 1961, drake introduced the subtemporal approach 10, 11 which offers a. Three variations of the oz approach were studied using one, two or three bone flaps. Modifications to the orbitozygomatic approach are an example of the ongoing adaptation of skull base procedures to general neurosurgical practice. The pterional approach pa is a versatile anterolateral neurosurgical technique that enables access to reach different structures contained in the cranial fossae. Orbitozygomatic craniotomy the neurosurgical atlas, by.
The mini orbitozygomatic moz approach has been commonly used to treat anterior communicating artery, internal carotid artery bifurcation, and superior cerebellar artery aneurysms. Removal of the orbital rim and the zygomatic arch can be associated with frontotemporal craniotomy to gain additional space, so as to decrease cerebral retraction. Most of the studies published have focused on the surgical technique and the gained exposure. Get stepbystep, expert guidance on fundamental procedures in neurosurgery both in print and on video. Core techniques in operative neurosurgery, 2nd edition, provides the tools needed to hone existing surgical skills and learn new techniques, helping you minimize risk and achieve optimal outcomes for every procedure. Core techniques in operative neurosurgery 2nd edition pdf. Learn vocabulary, terms, and more with flashcards, games, and other study tools. This study discusses operative techniques and tips for these approaches. The orbitozygomatic craniotomy may augment exposure under the frontal lobe, through the sylvian fissure, along the tip of the temporal. This additional bone removal broadens the subfrontal trajectory and minimizes the need for brain retraction to access the floor of the anterior and middle skull base as. Orbitozygomatic craniotomy vanderbilt university medical. Pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. The orbitozygomatic approach was particularly useful in this case due to the nature of the gunshot wound where the bullet had traversed through the globe and orbit to the temporal fossa.
Also, combined with a pretemporal approach, it affords a good view of the interpeduncular cistern. Note that the incision is a few millimeters below the lower margin of the zygomatic arch, and finishes at the contralateral pupillary line. Orbitozygomatic fracture repairsfer surgery antibiotics. Temporarily removing this bone allows surgeons to reach deeper and difficult parts of the brain while minimizing severe damage to the brain. The orbitozygomatic approach provides wide, multidirectional access to the anterior and middle cranial fossae, as well as to the upper third of the posterior fossa and clivus the technique eliminates the need for bone reconstruction of the orbital walls to prevent enophthalmos and minimizes the risk of injury to the frontal branch of the facial nerve 3. Bilateral frontoorbitozygomatic craniotomya combined extended frontal and orbitozygomatic approach. Increased bone removal from the skull base obviates the need for vigorous brain retraction and offers an improved multiangled trajectory and shallower operative field. Gupta sk, khosla vk, sharma bs department of neurosurgery, postgraduate institute of medical education and research, chandigarh, 160012, india. Working area and angle of attack in three cranial base approaches. Orbitozygomatic craniotomy brain tumor surgery johns. Mar 02, 2020 the orbitozygomatic craniotomy oz involves an expansion of the pterional approach through osteotomy of various sections of the superiorlateral orbital rimroof and zygoma. The frontotemporal orbitozygomatic ftoz approach is widely used for accessing anterolateral lesions in skull base surgery.
Frontotemporoorbitozygomatic craniotomy and halfandhalf. Oct 18, 2016 based upon the workhorse pterional craniotomy, orbitozygomatic approaches extend the exposure to allow better access to the cavernous sinus, posterior fossa and middle fossa. Translamina terminalis approach assisted by endovascular. In this paper, we describe the technique as well as numerous modifications developed in order to suit the various pathologies in the anterior and middle cranial fossae. The infratemporal fossa itf is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Microsurgical clipping through the translamina terminalis approach combined with an endovascular technique can be effective for basilar tip aneurysms. Orbitozygomatic fracture repairsfer free download as powerpoint presentation. Twentyseven patients had vascular lesions and twentytwo suffered for intracranial skull base tumors. Complete removal of the orbitozygomatic bar increases the angles of exposure, decreases the working depth of the surgical field, and minimizes brain retraction. Drilling down the pterion raises this roof, but not nearly as much as removing orbital walls.
Note that the scalp incision crosses to the opposite midpupillary line. Scribd is the worlds largest social reading and publishing site. The orbitozygomatic approach provides wide, multidirectional access to the anterior and middle cranial fossae, as well as to the upper third of the posterior fossa and clivus. The orbitozygomatic craniotomy oz involves an expansion of the pterional approach through osteotomy of various sections of the superiorlateral orbital rimroof and zygoma. The specific approaches used for each malignant neoplasm are given in table 2. Subciliary versus subtarsal approaches to orbitozygomatic. Currently, orbitozygomatic approaches comprise a group of surgical approaches to the skull base that. Based upon the workhorse pterional craniotomy, orbitozygomatic approaches extend the exposure to allow better access to the cavernous sinus, posterior fossa and middle fossa. The orbitozygomatic access was firstly described by hakuba, in 1986 1, 2 as the result of small changes to the frontotemporosphenoidal craniotomy 3, 4, 5 pterional craniotomy, popularized by yasargil in 1976, is the most used surgical route in neurosurgery 6, 7. Due to its difficult approach, surgical intervention at the itf has remained a heavy burden to surgeons. Increments in bony removal open a wider angle in which to work more than they increase the actual amount of working area.
Pterional craniotomy, popularized by yasargil in 1976, is the most used surgical route in neurosurgery 6, 7. The authors describe technical details of the surgical approach as it has evolved over 3. Drawing depicting the position of the patients head and the incision line for the orbitozygomatic skull base approach. Jan 11, 2019 the infratemporal fossa itf is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. The only disadvantage of this technique is the operative time required, which is longer than the standard pterional approach.
The orbitozygomatic approach achieves better exposure of basal structures with less brain retraction than the frontotemporal approach for lesions of the cranial base. Mini orbitozygomatic approach live surgery and chat with. The orbitozygomatic approach with maxillary extension had a significantly larger working area than the pterional approach p 0. The majority of these aneurysms project into the interhemispheric fissure. The orbitozygomatic craniotomy involves making an incision in the scalp behind the hairline and removing the bone that forms the contour of the orbit and cheek. The authors cover the fundamentals of using zygomatic implants, including the rationale behind the approach, anatomical and biomechanical considerations, imaging of the zygoma, correct implant trajectory, possible sinus.
By continuing to use our website, you are agreeing to our use of cookies. The paper is written in the lecture format and dedicated to one of the main basal approaches, the orbitozygomatic approach, that has been widely used by neurosurgeons for several decades. Cureus immersive surgical anatomy of the pterional approach. We emphasize that the basic ft approach, for us as for other authors, always includes resection of the sphenoid bridge frontotemporopterional craniotomy. Frontotemporoorbitozygomatic craniotomy and halfand. A, position of the head and skin incision for the 3piece orbitozygomatic approach. Original article frontotemporoorbitozygomatic craniotomy. Didactically describe the orbitozygomatic craniotomy made in three pieces. Subciliary versus subtarsal approaches to orbitozygomatic fr. The authors describe the historical background of the approach development and the surgical technique features and also analyze the published data about.