The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome

Youssef, A. Samy; Willard, Laura; Downes, Angela E.; Olivera, Raul; Hall, Kathryn L.; Agazzi, Siviero; Loveren, Harry van

doi:10.1007/s00701-012-1370-9

Cited by 31 publications

(33 citation statements)

References 35 publications

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“…In the neurosurgery literature, a review of 75 patients who underwent pterional surgery identified two (2.6%) cases of extraocular muscle restriction and three cases (4.0%) of ptosis. 12 The true rate of neuro-ophthalmic complications following pterional craniotomy is difficult to estimate. We encountered 8 patients with diplopia and ptosis over a 15 year period, during which 980 pterional craniotomies with orbital takedown were performed by two neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

et al. 2015

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Purpose To describe a newly recognized clinical syndrome consisting of ptosis, diplopia, vertical gaze limitation, and abduction weakness that can occur following orbital roof removal during orbito-zygomatic-pterional craniotomy. Design Case series. Participants Eight study patients, ages 44 – 80 years, 7 female, with neuro-ophthalmic symptoms after pterional craniotomy. Methods Case description of eight study patients. Main Outcome Measures Presence of ptosis, diplopia, and gaze limitation. Results Eight patients had neuro-ophthalmic findings after pterional craniotomy for meningioma removal or aneurysm clipping. The cardinal features were ptosis, limited elevation and hypotropia. Three patients also had limitation of downgaze and two had limitation of abduction. Imaging showed loss of the fat layers which normally envelop the superior rectus/levator palpebrae superioris. The muscles appeared attached to the defect in the orbital roof. Ptosis and diplopia developed in two patients despite Medpor titanium mesh implants. Deficits in all patients showed spontaneous improvement. In two patients a levator advancement was required to repair ptosis. In three patients an inferior rectus recession using an adjustable suture was performed to treat vertical diplopia. Follow-up a mean of 6.5 years later revealed that all patients had a slight residual upgaze deficit, but alignment was orthotropic in primary gaze. Conclusions After pterional craniotomy, ptosis, diplopia and vertical gaze limitation can result from tethering of the superior rectus/levator palpebrae superioris complex to the surgical defect in the orbital roof. Lateral rectus function is sometimes compromised by muscle attachment to the lateral orbital osteotomy. This syndrome occurs in about 1% of patients after removal of the orbital roof and can be treated, if necessary, by prism glasses or surgery.

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Section: Discussionmentioning

confidence: 99%

Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

et al. 2015

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“…Additionally, poor cosmetic outcomes have been described as a result of bony gaps created by osteotomies through the superior orbital ridge and body of the zygoma or sphenoid ridge resection [13]. Use of a standard craniotome results in a significant bony defect and possible risk to neural or orbital structures by direct injury, and often requires use of cranioplasty bone cement material to avoid cosmetic deformities.…”

Section: Discussionmentioning

confidence: 99%

Technical note: Orbitozygomatic craniotomy using an ultrasonic osteotome for precise osteotomies

Ruzevick

Raza

Recinos

et al. 2015

Clinical Neurology and Neurosurgery

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Background The orbitozygomatic craniotomy is a fundamental procedure in neurosurgery, allowing access to orbital and skull base pathology. Objective Determine the feasibility of using an ultrasonic osteotome to safely perform orbitozygomatic osteotomies in patients with intracranial pathology. Methods The medical records of patients undergoing orbitozygomatic craniotomy using an ultrasonic osteotome (Aesculap BoneScalpel™) for tumor resection at johns Hopkins Hospital between November 2009 and March 2013 were retrospectively reviewed. Results Six patients underwent orbitozygomatic craniotomy for tumor resection using an ultrasonic osteotome at the johns Hopkins Hospital during the study period. All patients were female and the average age was 53.2 years. Patients were followed for an average of 375 days. There were two cases of transient diplopia. There were no cases of periorbital violation, orbital injury, enophthalmos, or orbital hematoma. Post-operative imaging showed the cuts were well opposed and no cosmetic issues were encountered. Conclusion Use of an ultrasonic osteotome allows for precise cuts under direct visualization with minimal risk to critical adjacent structures in our cohort of patients undergoing a two-piece orbitozygomatic craniotomy. This appears to be a safe instrument for osteotomy creation in skull base approaches.

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“…The LSO approach is less traumatic, much faster, and simpler than the classic pterional approach and allows the surgeon to easily reach the sellar region [7]. The orbitozygomatic approach, also widely used and described in the context of sellar surgery in the literature [19] is, in our opinion, even more traumatic than the pterional one and needlessly extensive.…”

Section: Discussionmentioning

confidence: 99%

Lateral supraorbital approach applied to sellar tumors in 23 consecutive patients: the Suzhou experience from China

Chen

Dai

2013

World J Surg Onc

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BackgroundPituitary adenoma, craniopharyngioma and meningioma are common sellar lesions, accounting for more than 90% of sellar tumors. The aim of this study is to assess the reliability and safety of the lateral supraorbital (LSO) approach to remove sellar tumors.MethodsBetween June 2011 and December 2011, 23 patients with neoplastic lesions underwent surgery by the corresponding author (ZW) via the LSO approach. The clinical presentations, neuroradiological findings, microsurgical techniques, and outcome at discharge of these patients were analyzed. In addition, the clinical series in the available literature written in English were also extensively reviewed. Eleven (48%) patients were treated for pituitary adenoma; six (26%) patients for tuberculum sellae meningioma; and six (26%) patients for craniopharyngioma.ResultsSeemingly complete tumor removal was achieved in 21 patients (91%); surgical mortality was one patient (4.3%). Postoperatively, no patient had developed cerebrospinal fluid leakage or new visual deficits. One (4%) patient had intracranial infection, and one (4%) had a postoperative hematoma. The median Karnofsky score at discharge was 87.4 (range, 0 to 100). The Glasgow outcome scale at discharge was 4.6 (range, 1 to 5). Of all, 21 (91.3%) patients achieved favorable outcomes.ConclusionSellar tumors can be removed via the LSO approach with relatively low morbidity and mortality. Surgical results with this fast and simple approach are similar to those obtained with more extensive, complex, and time-consuming approaches.

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The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome

Cited by 31 publications

References 35 publications

Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

Technical note: Orbitozygomatic craniotomy using an ultrasonic osteotome for precise osteotomies

Lateral supraorbital approach applied to sellar tumors in 23 consecutive patients: the Suzhou experience from China

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