Frontotemporal orbitozygomatico-alar approachfor skull surgery

Abstract

Mobilisation of the zygoma has been reported to offer excellent exposure of the cranial base with minimal brain retraction. This study describes our operative technique and presents our experiences of 22 patients. Fifteen patients had a skull base neoplasm and 7 had a complex cerebral aneurysm. To facilitate access to these lesions, two separate bone flaps were created: (1) A free frontotemporal bone flap; and (2) en bloc removal of the superior and lateral orbital rims with the attached zygomatic arch. Because the latter bone flap includes both the orbital roof and the posterolateral wall of the orbit with the greater wing of the sphenoid bone, unnecessary bony defects which could cause enophthalmos or other cosmetic problems are avoided. Among the 22 patients, 17 have returned to their previous life style and four require assistance for personal care. Operative mortality was zero. The incidence of postoperative complications directly related to this approach was minimal and cosmetic results were acceptable in most patients. We recommend this approach for medially located skull base neoplasms or complex cerebral aneurysms.