The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications

Seçkin, Hakan; Avcı, Emel; Uluç, Kutluay; Niemann, David; Başkaya, Mustafa K.

doi:10.3171/foc.2008.25.12.e4

Cited by 85 publications

(45 citation statements)

References 40 publications

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“…The advantages of adding an orbitozygomatic or orbital osteotomy alone to the traditional FT craniotomy have been previously elucidated by various cadaveric studies and 3D quantitative models. 3,7,26,35,45,50 FTOZ has been shown to increase the surgical freedom and the projection angle while decreasing the amount of brain retraction required for adequate exposure. 3 However, in recent years, our experience in treating small to midsized sphenocavernous meningiomas and sphenoclinoidocavernous meningiomas has suggested that adequate exposure and maximal resection was possible with an FT craniotomy alone, followed by a combined extradural-intradural approach (Figs.…”

Section: Surgical Approachesmentioning

confidence: 99%

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Nanda

Thakur

Sonig

et al. 2016

JNS

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Cavernous sinus meningiomas (CSMs) represent a subset of intracranial tumors that continue to pose a formidable challenge to neurosurgeons. The various factors contributing to the challenging management of CSMs include not only their location, which limits their resectability and increases the risk of injuring critical neurovascular structures, but also achieving long-term tumor control and maintaining or improving patient quality-of-life outcomes. 1,5,6,9,10,13,20,21,27,30,32,38,41,44 Initially, CSMs were deemed inoperable due to the considerable mortality and morbidity related to removal of the tumor from what was deemed a surgically inaccessible area. With the introduction of the operating microscope and advances in neuroimaging, resection of these tumors became a realistic goal. The advances in microneurosurgical techniques in the 1980s and early 1990s allowed attempts at aggressive resection of these tumors. In the last 2 decades, the enthusiasm for aggressive resection has been tempered and the pendulum has swung toward a more conservative surgical strategy for treating the tumors of the parasellar compartment. Major factors that seem to be responsible for this paradigm shift include the efficacy and abbreviatioNs CN = cranial nerve; CND = CN dysfunction; CS = cavernous sinus; CSM = CS meningioma; ECA = external carotid artery; FT = frontotemporal; FTO = FT craniotomy with orbital osteotomy; FTOZ = FT orbitozygomatic; ICA = internal carotid artery; KPS = Karnofsky Performance Scale; MF = middle fossa; RT = radiotherapy; SRS = stereotactic radiosurgery. obJective Cavernous sinus meningiomas (CSMs) represent a cohort of challenging skull base tumors. Proper management requires achieving a balance between optimal resection, restoration of cranial nerve (CN) function, and maintaining or improving quality of life. The objective of this study was to assess the pre-, intra-, and postoperative factors related to clinical and neurological outcomes, morbidity, mortality, and tumor control in patients with CSM. methods A retrospective review of a single surgeon's experience with microsurgical removal of CSM in 65 patients between January 1996 and August 2013 was done. Sekhar's classification, modified Kobayashi grading, and the Karnofsky Performance Scale were used to define tumor extension, tumor removal, and clinical outcomes, respectively. results Preoperative CN dysfunction was evident in 64.6% of patients. CN II deficits were most common. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3-199 months]). The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreas...

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Section: Surgical Approachesmentioning

confidence: 99%

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Nanda

Thakur

Sonig

et al. 2016

JNS

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“…A detailed description of subfascial dissection to expose the zygoma, which is commonly used in the orbitozygomatic approach, is given in previous publications. 24,31 Blunt dissection is used to free the periorbita from the superior, medial, and lateral aspects of the orbital rims. The supraorbital nerves can be freed from the supraorbital notch with blunt dissection.…”

Section: Level I Craniofacial Approach and Illustrative Casesmentioning

confidence: 99%

Level I to III craniofacial approaches based on Barrow classification for treatment of skull base meningiomas: surgical technique, microsurgical anatomy, and case illustrations

Avcı

Aktüre

Seçkin

et al. 2011

FOC

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Object Although craniofacial approaches to the midline skull base have been defined and surgical results have been published, clear descriptions of these complex approaches in a step-wise manner are lacking. The objective of this study is to demonstrate the surgical technique of craniofacial approaches based on Barrow classification (Levels I–III) and to study the microsurgical anatomy pertinent to these complex craniofacial approaches. Methods Ten adult cadaveric heads perfused with colored silicone and 24 dry human skulls were used to study the microsurgical anatomy and to demonstrate craniofacial approaches in a step-wise manner. In addition to cadaveric studies, case illustrations of anterior skull base meningiomas were presented to demonstrate the clinical application of the first 3 (Levels I–III) approaches. Results Cadaveric head dissection was performed in 10 heads using craniofacial approaches. Ethmoid and sphenoid sinuses, cribriform plate, orbit, planum sphenoidale, clivus, sellar, and parasellar regions were shown at Levels I, II, and III. In 24 human dry skulls (48 sides), a supraorbital notch (85.4%) was observed more frequently than the supraorbital foramen (14.6%). The mean distance between the supraorbital foramen notch to the midline was 21.9 mm on the right side and 21.8 mm on the left. By accepting the middle point of the nasofrontal suture as a landmark, the mean distances to the anterior ethmoidal foramen from the middle point of this suture were 32 mm on the right side and 34 mm on the left. The mean distance between the anterior and posterior ethmoidal foramina was 12.3 mm on both sides; the mean distance between the posterior ethmoidal foramen and distal opening of the optic canal was 7.1 mm on the right side and 7.3 mm on the left. Conclusions Barrow classification is a simple and stepwise system to better understand the surgical anatomy and refine the techniques in performing these complex craniofacial approaches. On the other hand, thorough anatomical knowledge of the midline skull base and variations of the neurovascular structures is crucial to perform successful craniofacial approaches.

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“…The subfascial dissection is used to elevate the temporalis fascia and muscle to preserve facial nerve branches. As we describe elsewhere, the superolateral orbital rim is removed and the sphenoid ridge flattened to facilitate full exposure of the supraclinoid ICA; this is particularly helpful in cases of BBAs [6]. The distal Sylvian fissure is dissected widely to reduce the use of retractors.…”

Section: Openingmentioning

confidence: 98%

How I do it: treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery by extracranial-to-intracranial bypass and trapping

2014

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The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications

Cited by 85 publications

References 40 publications

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Level I to III craniofacial approaches based on Barrow classification for treatment of skull base meningiomas: surgical technique, microsurgical anatomy, and case illustrations

How I do it: treatment of blood blister-like aneurysms of the supraclinoid internal carotid artery by extracranial-to-intracranial bypass and trapping

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