Immersive Surgical Anatomy of the Frontotemporal-Orbitozygomatic Approach

Rubio, Roberto Rodriguez; Chae, Ricky; Kournoutas, Ioannis; Abla, Adib A.; McDermott, Michael W.

doi:10.7759/cureus.6053

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…In addition to the overarching factors informing approach selection, a number of variations and nuances have been described for each craniotomy that may vary based on patient and surgeon preferences, among other factors. The orbitozygomatic craniotomy has been described in 1-, 2-, and 3-piece variations, as well as at least 2 different "modified orbitozygomatic" techniques [4,6,7,9]. Ultimately, data is limited regarding the relative risks and benefits of these approaches; however, in our experience, we have relied on the standard 2-piece technique described above and the 3-piece technique to balance the needs of efficiency and safety.…”

Section: Discussionmentioning

confidence: 99%

“…The orbitozygomatic craniotomy has been described in one-, two-, and three-piece variations, as well as at least two different "modified orbitozygomatic" techniques. 4,6,7,9 Ultimately, data are limited regarding the relative risks and benefits of these approaches; however, in our experience, we have relied on the standard two-piece technique described above and the three-piece technique to balance the needs of efficiency and safety. Similarly, although we prefer the craniotome, the osteotomies may also be completed with a reciprocating saw, which is a less protected instrument, but one that provides narrower cuts that may be associated with more favorable cosmesis and healing.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding these features in turn informs preoperative decision-making, patient counseling, intraoperative technique, and postoperative care and follow-up. An important, commonly encountered, and illustrative example of approaches requiring thoughtful discrimination and execution are the frontotemporal craniotomy and its orbitozygomatic modification [4][5][6][7][8][9]. The goal of the current study was to provide step-by-step cadaveric dissections demonstrating and contrasting each approach for neurosurgical trainees, supplemented by illustrative case examples, and key pearls for their clinical application.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Frontotemporal and Orbitozygomatic Craniotomies

Carlstrom

Graffeo

Leonel

et al. 2023

J Neurol Surg B Skull Base

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Introduction: Although many neuroanatomic atlases a, few have detailed complex cranial approaches and pertinent anatomic considerations in a stepwise fashion intended for rapid comprehension by neurosurgery trainees. Methods: Five sides of formalin-fixed latex-injected specimens were dissected under microscopic magnification. The frontotemporal and orbitozygomatic approaches were performed by neurosurgical residents and fellows at different training levels with limited previous experience in anatomical dissection mentored by the senior authors. Meticulous surgical anatomic dissections were performed until sufficient visual and technical completion was attained, with parameters of effectively demonstrating key surgical steps for educational training purposes. Following completion of dissection and three-dimensional photography, illustrative case examples were reviewed to demonstrate the relative benefits and optimal applications of each approach. Results: The frontotemporal and orbitozygomatic approaches afford excellent access to anterior and middle skull base pathologies, as well as exposure of the infratemporal fossa. Key considerations include head positioning, skin incision, scalp retraction, fat pad dissection and facial nerve protection, true or false MacCarty keyhole fashioning, sphenoid wing drilling and anterior clinoidectomy, completion of the craniotomy and accessory orbital osteotomy cuts, dural opening, and intradural neurovascular access. Conclusion: The frontotemporal and orbitozygomatic approaches are core craniotomies that offer distinct advantages for complex cranial operations. Learning and internalizing their key steps and nuanced applications in a clinical context is critical for trainees of many levels. The orbitozygomatic craniotomy is a versatile but challenging approach; operative-style laboratory dissection is an essential component of its mastery, and one that will be powerfully enhanced by the current work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Frontotemporal and Orbitozygomatic Craniotomies

Carlstrom

Graffeo

Leonel

et al. 2023

J Neurol Surg B Skull Base

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“…Immersive anatomy experiences of cranial approaches developed with photogrammetry have been reported by Rodriguez Rubio et al and others. [24][25][26][27] Similarly, Qlone, an app that performs 360°photogrammetry using mobile devices, has been used to create macroscopic and sectional 3D models of the brain and brainstem. 7,28 However, a caveat of photogrammetry is that it is difficult to create 3D models that accurately represent a microsurgical perspective.…”

Section: Photogrammetry: Traditional Vs Our Novel Techniquementioning

confidence: 99%

Anatomic Depth Estimation and 3-Dimensional Reconstruction of Microsurgical Anatomy Using Monoscopic High-Definition Photogrammetry and Machine Learning

González-Romo

Hanalıoğlu

Mignucci-Jiménez

et al. 2022

Operative Neurosurgery

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BACKGROUND: Immersive anatomic environments offer an alternative when anatomic laboratory access is limited, but current three-dimensional (3D) renderings are not able to simulate the anatomic detail and surgical perspectives needed for microsurgical education. OBJECTIVE: To perform a proof-of-concept study of a novel photogrammetry 3D reconstruction technique, converting high-definition (monoscopic) microsurgical images into a navigable, interactive, immersive anatomy simulation. METHODS: Images were acquired from cadaveric dissections and from an open-access comprehensive online microsurgical anatomic image database. A pretrained neural network capable of depth estimation from a single image was used to create depth maps (pixelated images containing distance information that could be used for spatial reprojection and 3D rendering). Virtual reality (VR) experience was assessed using a VR headset, and augmented reality was assessed using a quick response code-based application and a tablet camera. RESULTS: Significant correlation was found between processed image depth estimations and neuronavigation-defined coordinates at different levels of magnification. Immersive anatomic models were created from dissection images captured in the authors' laboratory and from images retrieved from the Rhoton Collection. Interactive visualization and magnification allowed multiple perspectives for an enhanced experience in VR. The quick response code offered a convenient method for importing anatomic models into the real world for rehearsal and for comparing other anatomic preparations side by side. CONCLUSION: This proof-of-concept study validated the use of machine learning to render 3D reconstructions from 2-dimensional microsurgical images through depth estimation. This spatial information can be used to develop convenient, realistic, and immersive anatomy image models.

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Surgical management of bony orbit tumors

El-Sawy

Moawad

2022

Egypt J Neurol Psychiatry Neurosurg

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Background A variety of primary tumors affect the bony orbit. They include, sphenoid ridge meningioma, fibrous dysplasia, ossifying fibroma, osteoma and aneurismal bone cyst. Controversies in the treatment strategies still exist. This study is retrospective study that included 20 patients operated upon in the last three years—at neurosurgery department in Minia University Hospital—with tumors related to the bony orbit. We studied the data, to see what was done, what should have been done. CT and MRI were used for all patients preoperatively and for postoperative follow-up. Results Fourteen patients had sphenoid ridge meningiomas, two patients had osteomas, two patients had fibrous dysplasia, one had ossifying fibromas and one aneurysmal bone cyst. Proptosis improved in all cases. But one patient had deterioration of vision. There were no postoperative cases of enophthalmos or pulsating exophthalmos. Conclusions Early surgical intervention is mandatory before the tumor becomes less amenable. Both CT and MRI should be done preoperatively. Opening the bony superior orbital fissure is a mandatory step in all cases, whereas the optic canal should be drilled out open only if the optic nerve is compromised within the canal. Thorough knowledge of the skull base operative techniques is a must.

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Immersive Surgical Anatomy of the Frontotemporal-Orbitozygomatic Approach

Cited by 4 publications

References 22 publications

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Frontotemporal and Orbitozygomatic Craniotomies

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Frontotemporal and Orbitozygomatic Craniotomies

Anatomic Depth Estimation and 3-Dimensional Reconstruction of Microsurgical Anatomy Using Monoscopic High-Definition Photogrammetry and Machine Learning

Surgical management of bony orbit tumors

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