Abstract
The frontotemporal-orbitozygomatic (FTOZ) approach is widely used for accessing anterolateral lesions in skull base surgery. Many studies have described the technique and quantified the surgical exposure and freedom provided by the FTOZ approach. However, few studies have provided a detailed analysis of the technique and surgical landmarks using three-dimensional (3D) models. In this study, we aimed to create a collection of volumetric models (VMs) and stereoscopic media on the step-by-step surgical technique of the FTOZ approach using cadaveric dissections. The FTOZ approach was divided into eight major steps: positioning, incision of the skin, dissection of scalp flap, mobilization of the temporalis muscle, dissection of periorbita, craniotomy, drilling of basal structures, and dural opening. The MacCarty keyhole and inferior orbital fissure are major surgical landmarks that were referenced for the six bony cuts. Photogrammetry and structured light scanning were used to construct high-resolution VMs. We illustrated the two-piece FTOZ craniotomy, followed by the one-piece and three-piece FTOZ craniotomies. Stereoscopic images, videos, and VMs were produced for each step of the surgical procedure. In addition, the mini-orbitozygomatic (MOz) and orbitopterional (OPt) approaches were considered and described as possible alternatives to the FTOZ approach. Recent advances in 3D technology can be implemented in neurosurgical practice to further enhance our spatial understanding of neurovascular structures. Surgical approaches should be carefully selected and tailored according to the patient’s unique pathology and needs.
Highlights
The frontotemporal-orbitozygomatic (FTOZ) approach is an extension of the standard pterional approach (PA), and it provides wide exposure of the orbit and anterior, middle, and posterior cranial fossae
In the FTOZ approach, similar to the pterional approach, the superficial layers of the frontotemporal region are carefully dissected to preserve the temporal branches of the facial nerve (TBFN) and mobilize the temporalis muscle
While the MOz approach provides a smaller craniotomy than the standard FTOZ approach, there can be comparable surgical exposure depending on the accurate placement of the keyhole craniotomy (Interactive Model 7)
Summary
The frontotemporal-orbitozygomatic (FTOZ) approach is an extension of the standard pterional approach (PA), and it provides wide exposure of the orbit and anterior, middle, and posterior cranial fossae. The FTOZ approach involves dissection of the periorbita to elevate the zygoma, orbital roof, and superior and lateral walls of the orbit as a second bone flap. The removal of this orbitozygomatic bone piece ensures maximum exposure of intradural structures while improving cosmetic outcomes and eliminating the need for additional bone reconstruction around the orbit. Through the use of volumetric models (VMs) and stereoscopic media, this article aims to demonstrate a threedimensional (3D) orientation of surgical landmarks and techniques of the FTOZ approach
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