The introduction of the techniques of cranial base surgery has offered an unquestionable contribution to the neurosurgical treatment of certain difficult deep-seated lesions. The practice of skull base surgery demands a particular skill, which mainly results from long training with the modem techniques of bone microdissection. It also requires the availability of modem technology such as high-powered drills and oscillating-vibrating saws.The fronto-orbito zygomatic approach is part of the technical armamentarium a cranial base surgeon can use for dealing with lesions located in the area of superior orbital fissure, cavemous sinus, the petrous apex, and the interpeduncular fossa. As described in the literature,1'2 this approach requires a complex instrumentarium to be performed, as does any cranial base surgery. We describe here a technical modification which enables this useful cranial bone flap to be raised and replaced without costly modem technology.
MATERIALS AND METHODSA curvilinear skin incision is performed starting 3 cm below the zygomatic process in front of the external auditory meatus just behind the superficial temporal artery, and terminates 4 cm past the midline behind the hairline. After the skin flap is reflected anteriorly with fish hooks, the frontal pericranium is elevated in a posteriorto-anterior direction until the supraorbital nerve is exposed and can be mobilized away from the orbit. The periorbita is then visualized and carefully dissected away from the orbital wall. Then the zygoma is fully exposed, using a technique described in a previous paper3 for preventing injury of the frontal branches of the facial nerve. Briefly, soft tissue dissection is conducted between the deep layer of the superficial temporal fascia and the deep temporal fascia, and the zygoma is exposed subperioste-125 Skull
The authors report three cases of ductus venosus calcification as an additional cause of vascular liver calcification in the newborn. All three infants had umbilical venous catheters. The calcification may be caused by extravasated fluids given through the catheter or by local trauma due to catheter insertion. An obliquely oriented, paravertebral "tram-track" calcification in the right upper quadrant, particularly in a premature infant with a history of umbilical venous catheterization, should suggest the diagnosis of calcified ductus venosus.
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