Fronto-orbitozygomatic Approach Research Articles

Primary intraorbital inflammatory lumpy lesion: A rare case report.

Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery. This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case. Orbital EAF. Surgical radical resection and postoperative glucocorticoid therapy. After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief. EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.

Anterolateral Routes to the Skull Base-The Frontotemporal Approaches and Exposure of the Sellar and Parasellar Regions.

Surgical approaches to the sellar and parasellar regions are highly challenging due to the densely packed nature of the traversing neurovasculature. The frontotemporal-orbitozygomatic approach offers a wide angle of exposure for the management of lesions involving the cavernous sinus, parasellar region, upper clivus, and adjacent neurovascular structures. It combines the pterional approach with different osteotomies that remove the superior and lateral walls of the orbit and zygomatic arch. Extradural exposure and preparation of the periclinoid region, whether as initial preparation for a combined intraextradural approach to deep-seated skull base targets or as the main avenue of surgical exposure, can substantially enlarge surgical corridors and minimize the need for brain retraction in this very confined microsurgical space. We provide a stepwise description of how we perform the fronto-orbitozygomatic approach and an associated series of surgical maneuvers and techniques that can be utilized in a variety of anterior and anterolateral approaches, either alone or in combination, to tailor exposure to a given lesion. These techniques are not limited to traditional skull base approaches and represent a valuable addition to every neurosurgeon's armamentarium as enhancements to common surgical approaches.

Clinical effect of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement.

The objective of the study is to investigate the surgical methods and clinical effects of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement. The relationships between skull base tumors and internal carotid artery (ICA), tumor location and size, and the extent of tumor invasion were assessed. Preoperative CT perfusion (CTP), magnetic resonance (MR) perfusion-weighted imaging (PWI) (MR-PWI), and digital subtraction angiography (DSA) were performed to evaluate collateral circulation and brain tissue perfusion. Then craniotomy through the fronto-orbitozygomatic approach was performed, based on which four cases received extended middle skull base approach+Dolenc approach + Fukushima bypass type I, and six cases received extended middle skull base approach+Fukushima bypass type III. After surgery, DSA, CT angiogram (CTA), and CTP/PWI were performed to evaluate the patency of the reconstructed vessels and cerebral perfusion, and contrast-enhanced MRI to evaluate the degree of tumor resection. All patients were followed up for 6-12months. Among the 10 cases investigated, gross total resection was achieved in 8 cases, subtotal resection in 1 case, and partial resection in 1 case, as confirmed by CT and enhanced MRI. The patency of revascularization vessels was observed using fluorescein angiography during the operation in all patients and via DSA and CTA postoperatively in nine patients. One patient underwent ventilator-assisted ventilation because of respiratory failure and failed to undergo DSA and CTA. Regarding postoperative complications, one patient developed watershed cerebral infarction on the operated side but no sequelae after drug treatment, three patients developed facial numbness, which improved after 3months, and two patients experienced worsened diplopia. After 6 to 12months of follow-up on the nine evaluable patients, the Glasgow Outcome Scale (GOS) was 4-5 after surgery. In addition, 6-month follow-up results showed that one patient with clival chondrosarcoma developed recurrence on contrast-enhanced MRI, while no relapse was observed in the other patients. For skull base tumors with intracranial and extracranial invasion and involving the ICA, revascularization might improve the total resection rate and reduce the recurrence rate and risk of intraoperative bleeding and postoperative ischemia.

Successful eradication of a large orbital hydatid cyst without rupture using fronto-orbitozygomatic approach, the first case reported from Syria

Hydatid disease is a parasitic infection resulted by Echinococcus granulosus in the larval stage and is most prevalent in the Middle East, India, Africa, South America, New Zealand, Australia, Turkey and Southern Europe. However, orbital hydatid cysts are rare and represent a challenge to the surgeon to eradicate the cyst without rupture. Here, we report a case of a relatively large primary intraconal orbital cyst in a 21-year-old woman. We managed to eradicate the cyst without any complication using fronto-orbitozygomatic approach, and the patient remained disease free after the 3 months of follow-up.

Microsurgery for Upper Basilar Tip Aneurysm With Intraoperative Rupture: 3-Dimensional Operative Video.

In the last years, a shift from the microsurgical treatment to an endovascular therapy in patients with basilar apex aneurysm has been settled, part of this phenomenon is related to the significant tendency of vital perforators to be involved in the aneurysm dissection and clipping, which can implicate unfavorable outcomes. Nevertheless, microsurgical treatment remains the treatment that can provide the superior rates of stable and durable aneurysm occlusion, which is most important to young patients.In this video, we present the case of a 45-yr-old female patient who complained of a sudden and severe headache and presented with progressive lethargy during the following 3 d.At admission, computed tomography did not show abnormal findings. However, cerebrospinal fluid analysis showed erythrocytes and corroborated the clinical suspicion of spontaneous subarachnoid hemorrhage. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.Angiography and magnetic resonance imaging revealed a saccular basilar apex aneurysm. It showed a wide neck as well as a lobulated dome with upward and slightly left projection. The aneurysm did not involve angiographically visible thalamoperforator arteries, which allowed the microsurgical treatment by the fronto-orbitozygomatic approach. However, during the interpeduncular cistern dissection, an intraoperative rupture of the aneurysm occurred. This video exemplifies the steps required to manage an intraoperative rupture of a basilar apex aneurysm.

Fronto-orbitozygomatic approach: functional and cosmetic outcomes in a series of 169 patients.

OBJECTIVE Advantages of the fronto-orbitozygomatic (FOZ) approach have been reported extensively in the literature; nevertheless, restoration of normal anatomy and the esthetic impact of surgery are increasingly important issues for patients and neurosurgeons. The aim of this study was to analyze functional and cosmetic outcomes in a series of 169 patients with different pathologies who underwent surgery in which the FOZ approach was used. METHODS Between January 2000 and December 2014, 250 consecutive patients underwent surgery with an FOZ approach as the primary surgical treatment. Follow-up data were available for only 169 patients; 103 (60.9%) of these patients were female and 66 (39.1%) were male, and their ages ranged from 6 to 77 years (mean 46.9 years; SD 15.6 years). Mean follow-up time was 66 months (range 6-179 months; SD 49.5 months). Evaluation of clinical outcomes was performed with a focus on 4 main issues: surgical complications, functional outcome, cosmetic outcome, and patient satisfaction. The additional time needed to perform orbitotomy and orbital reconstruction was also evaluated. RESULTS The permanent postoperative complications included forehead hypesthesia (41.4%) and dysesthesia (15.3%), frontal muscle weakness (10.3%), exophthalmos (1.4%), enophthalmos (4.1%), diplopia (6.6%; 2% were related to surgical approach), and persistent periorbital and eyelid swelling (3%). Approximately 90% of the patients reported subjectively that surgery did not affect their quality of life or complained of only minor problems that did not influence their quality of life significantly. The mean time needed for orbitotomy and orbital reconstruction was approximately half an hour. CONCLUSIONS Comprehensive knowledge of the potential complications and overall clinical outcomes of the FOZ approach can be of great utility to neurosurgeons in balancing the well-known benefits of the approach with potential additional morbidities.

Surgical Approaches to the Orbital Apex: Comparison of Endoscopic Endonasal and Transcranial Approaches using a Novel 3D Endoscope

Introduction: Extended endoscopic endonasal approaches are increasingly applied to treat a variety of orbital pathologies. We performed a cadaveric study, comparing the endonasal approach with a transcranial approach to the orbital apex, using a two-dimensional (2D) and novel three-dimensional (3D) endoscope.Materials and methods: Dissection was performed on two fresh cadaver heads using a novel 3D endoscope for the endonasal approach to the orbit and orbital apex. On the same heads, a fronto-orbito-zygomatic (FOZ) approach was performed to expose the orbital apex region. Anatomical boundaries and limitations of each exposure were noted. 2D and 3D images of the approaches and anatomical dissections were captured and recorded.Results: The endonasal endoscopic approach achieved direct exposure to the inferior and medial aspects of the orbit. The FOZ approach, on the other hand, provided excellent access to the superior and lateral aspects of the orbit. Appreciation of the spatial relationships of the intracranial skull base anatomy was significantly improved using the 3D endoscope compared with the 2D endoscope.Conclusions: The endoscopic endonasal approach achieves direct exposure to the inferomedial aspect of the orbit and orbital apex, which is not exposed using the transcranial approach, hence the two approaches are complementary. 3D endoscopes augment the spatial orientation of extracranial and intracranial anatomical structures. This may improve patient’s safety and hasten the learning curve for endoscopic approaches to the midline skull base.

Orbital lesions and techniques

This article outlines the various lesions that commonly involve the orbit. The important elements of the evaluation of the orbit are discussed as well as the many different surgical approaches that are used with orbital lesions. The choice of approach primarily depends on the size and location of the mass. The salient points of the anatomy of the superior orbit are also detailed. The surgical technique of the superior orbitotomy and fronto-orbitozygomatic approach is described in detail.

Fronto-Orbito Zygomatic Approach: A Technical Modification

The fronto-orbito zygomatic approach is part of the surgical armamentarium of modern skull base surgery. As described in the literature, it requires costly technological tools such as powerful drills and saws, to be performed. In the present communication we describe a technical modification that allows the zygoma to be elevated "en bloc" together with the fronto-orbital bone flap by means of appropriate use of the Gigli's saw. Using this technique, adequate replacement of the craniotomy flap requires only two silk sutures. This technical modification, which was already successfully used in over 20 cases, would also allow this useful approach to be performed in those neurosurgical environments where modern costly technology for cranial base surgery is not available.