Frontoorbito zygomatic approach pubmed central pmc. The terms unilateral transbasal and orbitozygomatic infratemporal are synonyms of the term orbitozygomatic. The orbitozygomatic oz approach is an extension of the basic frontotemporal ft approach, which is associated with an oz osteotomy and eventually with zygomatic arch resection. It is based on the concept that it is safer to remove extra bone than to unnecessarily manipulate the brain. Techniques for preservation of the frontotemporal branch of facial nerve during orbitozygomatic approaches toma spiriev1 lars poulsgaard1 kaare fugleholm1 1departmentofneurosurgery,rigshospitaletcopenhagenuniversity. The approach has been applied effectively to neoplastic and vas.
Orbitozygomatic craniotomy the neurosurgical atlas, by. Management depends on a thorough preoperative physical examination, with attention to the ophthalmologic assessment. Increased bone removal from the skull base obviates the need. This is the basis for the orbitozygomatic approach fig. Since then, an orbitozygomatic approach has been adopted in surgeries for inaccessible lesions, such as cavernous sinus tumors,3, 4 cerebral peduncle and mesial temporal lobe lesions, 4 and orbital tumors 5 with various modifications. The orbitozygomatic approach oza, along with the pterional approach, is one of the most versatile anterolateral approaches to the skull base. Lateral orbital rim osteotomy in the treatment of certain. The orbitozygomatic approach provides wide, multidirectional access to the anterior and middle cranial fossae, as well as to the upper third of the posterior fossa and clivus the technique. This allows a wide exposure of the frontoorbital region on the side of the approach. This approach exposes the entire temporal lobe in order to offer the transylvian and lateral subfrontal views, from the pterional craniotomy, as well as subtemporal and temporopolar views to access the interpeduncular fossa.
Orbitozygomatic fracture repairsfer surgery antibiotics. Orbitozygomatic fracture repairsfer free download as powerpoint presentation. Many studies have described the technique and quantified the surgical exposure and freedom provided by the ftoz approach. Orbitozygomatic approach operative neurosurgery oxford. The orbitozygomatic approach is a modification and extension of the ph.
Orbitozygomatic craniotomy and transsylvian approach for. The orbitozygomatic approach is a modification and extension of the pterional craniotomy to gain a wider exposure of structures at a crania we use cookies to enhance your experience on our website. Microsurgical clipping through the translamina terminalis approach combined with an endovascular technique can be effective for basilar tip aneurysms. The orbitozygomatic approach provides access to the anterior and middle cranial fossae as. Based upon the workhorse pterional craniotomy, orbitozygomatic approaches extend the exposure to allow better access to the cavernous sinus, posterior fossa and middle fossa. The orbitozygomatic approach is a modification and extension of the pterional craniotomy to gain a wider exposure of structures at a cranial base. The frontotemporal orbitozygomatic ftoz approach is widely used for accessing anterolateral lesions in skull base surgery.
The authors describe the technical details of the supraorbital and subtemporal modified orbitozygomatic approaches and discuss the surgical indications for their use. We applied a cranioorbitalzygomatic approach that extends the temporal craniotomy more posteriorly and minimizes the frontal orbitotomy of an ordinary orbitozygomatic approach in order to. The frontotemporal orbitozygomatic obz approach is considered one of the main accesses and one of the most applied procedures in skull base surgery 2, 10, 14, 22, 24. Orbitozygomatic approach the pterional approach is a traditional and versatile one that allows access to aneurysms in the anterior circulation. We emphasize that the basic ft approach, for us as for other authors, always includes resection of the sphenoid bridge frontotemporopterional craniotomy.
In a 3piece orbitozygomatic approach, soft tissue exposure is mostly comparable to the classic frontopterional approach. Some operative nuances are detailed in the video including. Osseous resection is a 3piece operation that consists of first. The orbitozygomatic approach provides access to the anterior and middle cranial fossae as well as the deep sellar and basilar apex regions. Frontiers cranioorbital and orbitocranial approaches to. We would say that this is the most versatile approach.
The addition of both the orbital and zygomatic osteotomies has expanded the limits. Operative nuances the orbitozygomatic approach wouter ralph van furth, m. The cranioorbital zygomatic approach has been in evolution since the frontal approach was first introduced. A cranioorbitalzygomatic approach to dumbbellshaped. An overview of the modified onepiece frontotemporoorbitozygomatic craniotomy by g narenthiran frcssn. Note that the scalp incision crosses to the opposite midpupillary line. Compared with the pterional craniotomy, the orbitozygomatic approach. The orbitozygomatic craniotomy has been developed and modified over the last three decades, and has become a quintessential approach and technique for the wellrounded neurosurgeon. By continuing to use our website, you are agreeing to our use of cookies. Stieg, phd, md a handson cadaver workshop with 3d virtual reality lectures 3day courses in new york city. It is based on the concept that it is safer to remove extra bone than to unnecessarily. An additional trick while performing an lso is to place a single or multiple stiches orbitozygomatic stich at the base of the dura once opened, eliminating the. The frontotemporal orbitozygomatic ftoz approach, initially described by pellerin et al. This additional bone removal broadens the subfrontal trajectory and minimizes the need for brain retraction to access the floor.
Orbitozygomatic fractures are frequently encountered in plastic surgery. Get a printable copy pdf file of the complete article 1. Orbitozygomatic craniotomy with modified zabramskis. Modified orbitozygomatic approach without orbital roof.
Orbitozygomatic temporopolar approach for a high basilar tip aneurysm associated with a short intracranial internal carotid artery. Consequently, a lateral orbital rim osteotomy was substituted for an orbitozygomatic craniotomy in seven patients with a variety of pathologies located in the anterior, middle, and interpeduncular fossae. Orbitozygomatic craniotomy vanderbilt university medical. Translamina terminalis approach assisted by endovascular. Zygomatic anterior subtemporal approach for lesions in the. To simplify the understanding and performance of the approach, we developed a teaching video that follows a systematic approach. Orbitozygomatic craniotomy brain tumor surgery johns. The orbitozygomatic craniotomy oz involves an expansion of the pterional approach through osteotomy of various sections of the superiorlateral orbital rimroof and zygoma. Modified onepiece orbitozygomatic approach youtube.
The interpeduncular cistern is a difficult region to approach through conventional methods due to its deep location and important adjacent neurovascular structures. Frontotemporalorbitozygomatic approach request pdf. Orbitozygomatic approach the orbitozygomatic approach oza, along with the pterional approach, is one of the most versatile anterolateral approaches to the skull base. It is necessary to remove the orbital wall sufficiently to realize the benefits of orbitozygomatic. Objective advantages of the fronto orbitozygomatic foz approach have been reported extensively in the. Complex surgical approaches to the skull base presented by. Management of infections complicating the orbitocranial.
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