Cranio-Orbito-Zygomatic Approach
Keywords:
Carotid-oculomotor Window; Optic-carotid Window; Orbito-Zygomatic Approach; Orbitopterional Approach; Pterional Craniotomy; Skull Base Approach; Surgical AnatomyAbstract
The cranio-orbito-zygomatic (COZ) approach consists of an extension of the pterional approach characterized by the removal of the superolateral part of the orbital rim and zygoma. This key step tremendously increases the angular exposure to some deep targets and overall surgical freedom to the lesion.
In this article we review the technical variations of the COZ approach, mainly focusing on the differential quantitative effects coming from the orbital osteotomy compared to the zygomatic one.
References
Pellerin P, Lesoin F, Dhellemmes P, Donazzan M, Jomin M. Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery. 1984;15(5):715-8.
Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986;26(3):271-6.
Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987;21(4):474-7.
Aziz KM, Froelich SC, Cohen PL, Sanan A, Keller JT, van Loveren HR. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien). 2002;144(1):15-24.
Delashaw JB, Jr., Tedeschi H, Rhoton AL. Modified supraorbital craniotomy: technical note. Neurosurgery. 1992;30(6):954-6.
Lemole GM, Jr., Henn JS, Zabramski JM, Spetzler RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg. 2003;99(5):924-30.
Delashaw J, Jane J, Kassell N, Luce C. Supraorbital craniotomy by fracture of the anterior orbital roof. Technical note. J Neurosurg. 1993;79:615-8.
Andaluz N, van Loveren HR, Keller JT, Zuccarello M. The One-Piece Orbitopterional Approach. Skull base : official journal of North American Skull Base Society [et al]. 2003;13(4):241-5.
Yaşargil M.G. FJL, Ray M.W. . The Operative Approach to Aneurysms of the Anterior Communicating Artery. In: al. KHe, editor. Advances and Technical Standards in Neurosurgery, vol 2. Vienna: Springer; 1975.
Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery. 1982;11(4):537-42.
Zabramski JM, Kiris T, Sankhla SK, Cabiol J, Spetzler RF. Orbitozygomatic craniotomy. Technical note. J Neurosurg. 1998;89(2):336-41.
McDermott M, Durity F, Rootman J, Woodhurst W. Combined frontotemporal-orbitozygomatic approach for tumors of the sphenoid wing and orbit. Neurosurgery. 1990;26:107-16.
Matsuo S, Komune N, Hayashi D, Amano T, Nakamizo A. Three-piece orbitozygomatic craniotomy: anatomical and clinical findings. World Neurosurg. 2019.
Campero A, Martins C, Socolovsky M, Torino R, Yasuda A, Domitrovic L, et al. Three-piece orbitozygomatic approach. Neurosurgery. 2010;66(suppl_1):ons-E119-ons-E20.
Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Microneurosurgical management of giant intracranial aneurysms: Datasets of a twenty-year experience. Data Brief. 2020;33:106537.
Luzzi S, Gragnaniello C, Giotta Lucifero A, Del Maestro M, Galzio R. Surgical Management of Giant Intracranial Aneurysms: Overall Results of a Large Series. World Neurosurg. 2020;144:e119-e37.
Oikawa S, Mizuno M, Muraoka S, Kobayashi S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy. Technical note. J Neurosurg. 1996;84(2):297-9.
Yasargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987;67(3):463-6.
Coscarella E, Vishteh AG, Spetzler RF, Seoane E, Zabramski JM. Subfascial and submuscular methods of temporal muscle dissection and their relationship to the frontal branch of the facial nerve. Technical note. J Neurosurg. 2000;92(5):877-80.
Shimizu S, Tanriover N, Rhoton AL, Jr., Yoshioka N, Fujii K. MacCarty keyhole and inferior orbital fissure in orbitozygomatic craniotomy. Neurosurgery. 2005;57(1 Suppl):152-9; discussion -9.
Alaywan M, Sindou M. Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy. Acta Neurochir (Wien). 1990;104(3-4):79-83.
Schwartz MS, Anderson GJ, Horgan MA, Kellogg JX, McMenomey SO, Delashaw JB, Jr. Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach. J Neurosurg. 1999;91(6):1020-6.
Ammirati M, Spallone A, Ma J, Cheatham M, Becker D. An anatomicosurgical study of the temporal branch of the facial nerve. Neurosurgery. 1993;33(6):1038-43; discussion 44.
Kadri PA, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg. 2004;100(3):517-22.
Chanda A, Nanda A. Anatomical study of the orbitozygomatic transsellar-transcavernous-transclinoidal approach to the basilar artery bifurcation. J Neurosurg. 2002;97(1):151-60.
al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg. 1990;73(5):668-73.
da Silva SA, Yamaki VN, Solla DJF, Andrade AF, Teixeira MJ, Spetzler RF, et al. Pterional, Pretemporal, and Orbitozygomatic Approaches: Anatomic and Comparative Study. World Neurosurg. 2019;121:e398-e403.
al-Mefty O, Smith RR. Tailoring the cranio-orbital approach. Keio J Med. 1990;39(4):217-24.
Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Siwanuwatn R, et al. Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex. Neurosurgery. 2005;56(2 Suppl):397-405; discussion 397-405.
Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery. 2002;50(3):550-5; discussion 5-7.
Lee JS, Scerrati A, Zhang J, Ammirati M. Quantitative analysis of surgical exposure and surgical freedom to the anterosuperior pons: comparison of pterional transtentorial, orbitozygomatic, and anterior petrosal approaches. Neurosurg Rev. 2016;39(4):599-605.
Pitelli SD, Almeida GG, Nakagawa EJ, Marchese AJ, Cabral ND. Basilar aneurysm surgery: the subtemporal approach with section of the zygomatic arch. Neurosurgery. 1986;18(2):125-8.
Tayebi Meybodi A, Benet A, Rodriguez Rubio R, Yousef S, Lawton MT. Comprehensive Anatomic Assessment of the Pterional, Orbitopterional, and Orbitozygomatic Approaches for Basilar Apex Aneurysm Clipping. Oper Neurosurg (Hagerstown). 2018;15(5):538-50.
Tayebi Meybodi A, Benet A, Rodriguez Rubio R, Yousef S, Mokhtari P, Preul MC, et al. Comparative Analysis of Orbitozygomatic and Subtemporal Approaches to the Basilar Apex: A Cadaveric Study. World Neurosurg. 2018;119:e607-e16.
Cavalcanti DD, Morais BA, Figueiredo EG, Spetzler RF, Preul MC. Accessing the Anterior Mesencephalic Zone: Orbitozygomatic Versus Subtemporal Approach. World Neurosurg. 2018;119:e818-e24.
Figueiredo EG, Tavares WM, Rhoton AL, Jr., de Oliveira E. Nuances and technique of the pretemporal transcavernous approach to treat low-lying basilar artery aneurysms. Neurosurg Rev. 2010;33(2):129-35; discussion 35.
Giotta Lucifero A, Baldoncini M, Bruno N, Tartaglia N, Ambrosi A, Marseglia GL, et al. Microsurgical Neurovascular Anatomy of the Brain: The Anterior Circulation (Part I). Acta Biomed. 2021;92(S4):e2021412.
Giotta Lucifero A, Baldoncini M, Bruno N, Tartaglia N, Ambrosi A, Marseglia GL, et al. Microsurgical Neurovascular Anatomy of the Brain: The Posterior Circulation (Part II). Acta Biomed. 2021;92(S4):e2021413.
Giotta Lucifero A, Fernandez-Miranda JC, Nunez M, Bruno N, Tartaglia N, Ambrosi A, et al. The Modular Concept in Skull Base Surgery: Anatomical Basis of the Median, Paramedian and Lateral Corridors. Acta Biomed. 2021;92(S4):e2021411.
Luzzi S, Del Maestro M, Elia A, Vincitorio F, Di Perna G, Zenga F, et al. Morphometric and Radiomorphometric Study of the Correlation Between the Foramen Magnum Region and the Anterior and Posterolateral Approaches to Ventral Intradural Lesions. Turk Neurosurg. 2019.
Luzzi S, Zoia C, Rampini AD, Elia A, Del Maestro M, Carnevale S, et al. Lateral Transorbital Neuroendoscopic Approach for Intraconal Meningioma of the Orbital Apex: Technical Nuances and Literature Review. World Neurosurg. 2019;131:10-7.
Zoia C, Bongetta D, Dorelli G, Luzzi S, Maestro MD, Galzio RJ. Transnasal endoscopic removal of a retrochiasmatic cavernoma: A case report and review of literature. Surg Neurol Int. 2019;10:76.
Luzzi S, Del Maestro M, Galzio R. Letter to the Editor. Preoperative embolization of brain arteriovenous malformations. J Neurosurg. 2019:1-2.
Arnaout MM, Luzzi S, Galzio R, Aziz K. Supraorbital keyhole approach: Pure endoscopic and endoscope-assisted perspective. Clin Neurol Neurosurg. 2019;189:105623.
Luzzi S, Del Maestro M, Elbabaa SK, Galzio R. Letter to the Editor Regarding "One and Done: Multimodal Treatment of Pediatric Cerebral Arteriovenous Malformations in a Single Anesthesia Event". World Neurosurg. 2020;134:660.
Luzzi S, Gragnaniello C, Giotta Lucifero A, Marasco S, Elsawaf Y, Del Maestro M, et al. Anterolateral approach for subaxial vertebral artery decompression in the treatment of rotational occlusion syndrome: results of a personal series and technical note. Neurol Res. 2021;43(2):110-25.
Del Maestro M, Rampini AD, Mauramati S, Giotta Lucifero A, Bertino G, Occhini A, et al. Dye-Perfused Human Placenta for Vascular Microneurosurgery Training: Preparation Protocol and Validation Testing. World Neurosurg. 2020.
Luzzi S, Gragnaniello C, Marasco S, Lucifero AG, Del Maestro M, Bellantoni G, et al. Subaxial Vertebral Artery Rotational Occlusion Syndrome: An Overview of Clinical Aspects, Diagnostic Work-Up, and Surgical Management. Asian Spine J. 2020.
Millimaggi DF, Norcia VD, Luzzi S, Alfiero T, Galzio RJ, Ricci A. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A Retrospective Database of 40 Consecutive Cases and Literature Review. Turk Neurosurg. 2018;28(3):454-61.
Luzzi S, Giotta Lucifero A, Del Maestro M, Marfia G, Navone SE, Baldoncini M, et al. Anterolateral Approach for Retrostyloid Superior Parapharyngeal Space Schwannomas Involving the Jugular Foramen Area: A 20-Year Experience. World Neurosurg. 2019;132:e40-e52.
Tanriover N, Ulm AJ, Rhoton AL, Jr., Kawashima M, Yoshioka N, Lewis SB. One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations. Neurosurgery. 2006;58(4 Suppl 2):ONS-229-37; discussion ONS-37.
Andaluz N, Van Loveren HR, Keller JT, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery. 2003;52(5):1140-8; discussion 8-9.
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Copyright (c) 2021 Sabino Luzzi, Alice Giotta Lucifero, Nunzio Bruno, Matias Baldoncini, Alvaro Campero, Renato Galzio
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