Cranio orbital zygomatic approach

The cranio-orbitozygomatic (COZ) approach recently became one of the most frequently employed skull base exposures in the neurosurgical armamentarium 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14)

It has been in evolution since the frontal approach was first introduced. The addition of both the orbital and zygomatic osteotomies has expanded the limits of neurosurgery to include orbital, craniofacial, and infratemporal pathology. The goal of any skull base approach is to shorten the operative working distance and reduce retraction of the brain while improving exposure. Utilizing the benefits afforded by the cranio-orbital zygomatic approach requires a thorough understanding of the extradural anatomy of the anterior and middle fossae, including the temporal bone, the craniofacial skeleton, and the cavernous sinus.

Videos

<html><iframe width=“420” height=“315” src=“https://www.youtube.com/embed/NCZCXhD3Onc” frameborder=“0” allowfullscreen></iframe></html>

The Cranio Orbital approach to Tuberculum Sella Meningioma

<html><iframe width=“420” height=“315” src=“https://www.youtube.com/embed/OsnKmR2QG5Y” frameborder=“0” allowfullscreen></iframe></html>

1)
Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery 1987;21:474-7
2)
Al-Mefty O, Anand VK. Zygomatic approach to skull-base lesions. J Neurosurg 1990;73:668-673
3)
Al-Mefty O. Operative atlas of Meningiomas. Lippincott, Williams, and Wilkins, 1998
4)
Andaluz N, van Loveren HR, Keller JT, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery 2003;52:1140-9
5)
Aziz KMA, Froelich SC, Cohen PL, et al. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien) 2002;144:15-24
6)
Delashaw JB Jr, Tedeschi H, Rhoton AL Jr: Modified supraorbital craniotomy: technical note. Neurosurgery 1992;30:954-6
7)
Frazier CH. An approach to the hypophysis through the anterior cranial fossa. Ann Surg 1913;57:145-52
8)
Fujitsu K, Kuwabara T. Orbitocraniobasal approach for anterior communicating artery aneurysms. Neurosurgery 1986;18:367-9
9)
Gonzalez LF, Crawford NR, Horgan MA, et al. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery 2002;50:550-7
10)
Hakuba A, Liu S, Nishinura S. The orbitozygomatic infratemporal fossa approach: a new surgical technique. Surg Neurol 1986;26:271-6
11)
Ikeda K, Yamashita J, Hashimoto M, Futami K. Orbitozygomatic temporopolar approach for a high basilar tip aneurysm associated with a short intracranial internal carotid artery: a new surgical approach. Neurosurgery 1991;28:105-10
12)
Ane JA, Park TS, Pobereskin LH, et al. The supraorbital approach: technical note. Neurosurgery 1982;11:537-42
13)
Lemole GM Jr, Henn JS, Zabramski JM, et al. Modifications to the orbitozygomatic approach. J Neurosurg 2003;99:924-30
14)
MacCarty CS, Brown DN. Orbital tumors in children. Clin Neurosurg 1964; 11:76-88