Orbitozygomatic craniotomy in three pieces: tips and tricks

Abstract

Objective Didactically describe the orbitozygomatic craniotomy made in three pieces. Method This approach was performed, from 2002 to 2011, in 49 patients admitted at Beneficência Portuguesa of São Paulo Hospital. Results Twenty-seven patients had vascular lesions and twenty-two suffered for intracranial skull base tumors. The vascular lesions varied from cavernous angiomas inside the mesencephalum, high bifurcation basilar tip aneurysms, superior cerebellar arteries aneurysms and arteriovenous malformations in the interpeduncular cistern. Skull base tumors as meningiomas, interpeduncular hamartomas and third ventricle floor gliomas were among the neoplastic lesions approached. We had no permanent injuries and minimal transient complications had occurred. Conclusion It is a descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, describing in details the technique in which this group of evolutionarily authors came to accomplish the task.

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

“…Similar burr holes are placed, but additional osteotomies are made through the zygoma and orbital walls to elevate a single or two-piece bone flap. 117 In addition to the dural exposure, the COZ approach also exposes the periorbita and provides larger working angles.…”

Immersive Surgical Anatomy of the Frontotemporal-Orbitozygomatic Approach

“…The FTOZ approach exposes structures within and in the vicinity of the cranial fossae (the basilar artery apex, orbital apex, petrous apex, upper clivus, infratemporal fossa, interpeduncular fossa, pterygopalatine fossa, and sellar/parasellar regions) and allows higher maneuverability than the PA [5,6]. Therefore, this approach may be used for several pathologies, such as pituitary macroadenomas, chordomas, sphenoid wing meningiomas, orbital meningiomas, petroclival meningiomas, trigeminal neurinomas, basilar tip aneurysms, anterior communicating artery aneurysms, and lesions of the cavernous sinus [7,8]. Preoperative assessment of the patient's pathology and medical history are essential for understanding the anatomy of the lesion and tailoring the surgical approach to fit the needs of each case.…”

Modified Orbitozygomatic Approach without Orbital Roof Removal for Middle Fossa Lesions

“…OBZ craniotomy combines the advantages of the pterional and pretemporal approaches, but improves the angle of the microscope view. Hence, it provides the best view for brain injuries in the floor of the anterior and middle cranial fossa [ 2 , 5 , 6 , 10 , 22 ].…”

“…Main variants of the OBZ approach include those in which osteotomies are performed as one-piece [ 1 , 2 , 22 , 24 ], two-piece [ 2 , 20 - 22 , 24 , 25 ], or three-piece bone flaps [ 4 , 5 , 18 ]. In all of these, a craniotomy is carried out that allows resection of the frontotemporal fragment, the roof, and the lateral wall of the orbit, of the zygoma lateral surface, and of the zygomatic process of temporal bone, in one, two, or three segments, respectively [ 24 ].…”