Modifications to the orbitozygomatic approach

2003 ◽  
Vol 99 (5) ◽  
pp. 924-930 ◽  
Author(s):  
G. Michael Lemole ◽  
Jeffrey S. Henn ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Complete Removal ◽  
Surgical Indications ◽  
Content Type ◽  
Orbitozygomatic Approach ◽  
Technical Details ◽  
Surgical Field ◽  
Brain Retraction ◽  
Fine Print

✓ The orbitozygomatic craniotomy is one of the workhorse approaches of skull base surgery, providing wide, multidirectional access to the anterior and middle cranial fossae as well as the basilar apex. Complete removal of the orbitozygomatic bar increases the angles of exposure, decreases the working depth of the surgical field, and minimizes brain retraction. In many cases, however, only a portion of the exposure provided by the full orbitozygomatic approach is needed. Tailoring the extent of the bone resection to the specific lesion being treated can help lower approach-related morbidity while maintaining its advantages. The authors describe the technical details of the supraorbital and subtemporal modified orbitozygomatic approaches and discuss the surgical indications for their use. Modifications to the orbitozygomatic approach are an example of the ongoing adaptation of skull base procedures to general neurosurgical practice.

Charles Labbé (1851–1889)

1997 ◽  
Vol 87 (3) ◽  
pp. 477-480 ◽  
Author(s):  
Ronald H. M. A. Bartels ◽  
Jacobus J. Van Overbeeke
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Public Records ◽  
Content Type ◽  
Extensive Search ◽  
Vein Of Labbé ◽  
First Time ◽  
Important Structure ◽  
Fine Print

✓ The vein of Labbé is a very important structure and every neurosurgeon is acquainted with its anatomy. Because of the recent increasing interest and experience in skull base surgery, the vein of Labbé has received a great deal of attention. Intraoperative damage to this vein should be avoided and several methods to prevent this have been described. Despite these developments, nothing is written in the neurosurgical literature about the man who described this vein for the first time: Charles Labbé. The authors therefore conducted an extensive search of the literature and uncovered several public records in France to learn more about Charles Labbé.

Orbitozygomatic craniotomy

1998 ◽  
Vol 89 (2) ◽  
pp. 336-341 ◽  
Author(s):  
Joseph M. Zabramski ◽  
Talat Kiriş ◽  
Suresh K. Sankhla ◽  
Josep Cabiol ◽  
Robert F. Spetzler
Keyword(s):  
Bone Reconstruction ◽  
Modified Technique ◽  
Content Type ◽  
Risk Of Injury ◽  
Orbitozygomatic Approach ◽  
Technical Details ◽  
Upper Third ◽  
Frontal Branch ◽  
Fine Print

✓ The orbitozygomatic approach provides wide, multidirectional access to the anterior and middle cranial fossae, as well as to the upper third of the posterior fossa and clivus. The authors describe technical details of the surgical approach as it has evolved over 3.5 years of experience in 83 consecutive cases. This modified technique eliminates the need for bone reconstruction of the orbital walls to prevent enophthalmos and minimizes the risk of injury to the frontal branch of the facial nerve. At a follow-up evaluation after a period averaging 14 months, all patients were pleased with the cosmetic results of this approach.

Trigeminal neurinomas extending into multiple fossae: surgical methods and review of the literature

1999 ◽  
Vol 91 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Kazunari Yoshida ◽  
Takeshi Kawase
Keyword(s):  
Skull Base ◽  
Clinical Features ◽  
Skull Base Surgery ◽  
Single Stage ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Developmental Patterns ◽  
Content Type ◽  
Total Tumor Removal ◽  
Fine Print

Object. Since 1974, 27 patients with trigeminal neurinomas (TNs) have been treated at Keio University Hospital and ancillary institutes. In the present study the clinical features and developmental patterns of these 27 cases are analyzed, and the clinical features of 402 cases reported in the literature are reviewed. Based on the analysis of the developmental patterns of the TNs, the surgical strategy for a one-stage removal of TNs involving multiple fossae is described.Methods. Trigeminal neurinomas are classified into six types according to tumor location. Types M, P, and E are tumors involving a single compartment, that is, the middle fossa, posterior fossa, or extracranial space, respectively. Types MP (middle and posterior fossae), ME (middle fossa and extracranial space), or MPE (middle and posterior fossae and extracranial space) are tumors involving multiple compartments. Advances in neuroimaging technologies, such as magnetic resonance imaging, have revealed a high incidence of TNs extending into multiple fossae, namely 36.2% in cases reported since 1983 and 59% in the authors' series. All but one of the most recent 19 patients in this series underwent skull base surgery, whereas the remaining nine patients were surgically treated via the conventional subdural approach. The rate of total tumor removal and the clinical outcome were significantly better in those patients treated by skull base surgery than those treated by conventional surgery.Conclusions. The TNs extending into multiple fossae can be totally removed using the following single-stage surgical techniques: Type MP by the anterior transpetrosal approach; Type ME by the zygomatic or orbitozygomatic infratemporal approach; and Type MPE by the zygomatic transpetrosal approach. In 12 of 13 cases involving multiple fossae in this series, total tumor removal was achieved using single-stage skull base surgery.

scholarly journals The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications

2008 ◽  
Vol 25 (6) ◽  
pp. E4 ◽  
Author(s):  
Hakan Seçkin ◽  
Emel Avci ◽  
Kutluay Uluç ◽  
David Niemann ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Individual Case ◽  
Surgical Instruments ◽  
Microsurgical Anatomy ◽  
Temporalis Fascia ◽  
Operative Field ◽  
Case Examples ◽  
Orbitozygomatic Approach ◽  
Brain Retraction

Object The aim of this study was to describe the microsurgical anatomy of the orbitozygomatic craniotomy and its modifications, and detail the stepwise dissection of the temporalis fascia and muscle and explain the craniotomy techniques involved in these approaches. Methods Nine cadaveric embalmed heads injected with colored silicone were used to demonstrate a stepwise dissection of the 3 variations of orbitozygomatic craniotomy. The craniotomies and dissections were performed with standard surgical instruments, and the microsurgical anatomy was studied under microscopic magnification and illumination. Results The authors performed 2-piece, 1-piece, and supraorbital orbitozygomatic craniotomies in 3 cadaveric heads each. Stepwise dissection of the temporalis fascia and muscle, and osteotomy cuts were shown and the relevant microsurgical anatomy of the anterior and middle fossae was demonstrated in cadaveric heads. Surgical case examples were also presented to demonstrate the application of and indications for the orbitozygomatic approach. Conclusions The orbitozygomatic approach provides access to the anterior and middle cranial fossae as well as the deep sellar and basilar apex regions. Increased bone removal from the skull base obviates the need for vigorous brain retraction and offers an improved multiangled trajectory and shallower operative field. Modifications to the orbitozygomatic approach provide alternatives that can be tailored to particular lesions, enabling the surgeon to use the best technique in each individual case rather than a “one size fits all” approach.

Extradural anterior clinoidectomy

2005 ◽  
Vol 102 (5) ◽  
pp. 945-950 ◽  
Author(s):  
Akio Noguchi ◽  
Vijayabalan Balasingam ◽  
Yoshiaki Shiokawa ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Anatomical Variations ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Anterior Clinoidectomy ◽  
Small Structure ◽  
Surgical Field ◽  
The Brain ◽  
Fine Print

✓ The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions—either tumors or aneurysms—in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subsequent derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

A new technique for exposure of the cervical spine laminae

2002 ◽  
Vol 96 (1) ◽  
pp. 122-126 ◽  
Author(s):  
Tateru Shiraishi
Keyword(s):  
Cervical Spine ◽  
New Technique ◽  
Diverse Range ◽  
Content Type ◽  
Spinous Processes ◽  
Technical Details ◽  
A New Technique ◽  
Fine Print

✓ The author describes a new technique for exposure of the cervical spine laminae in which the attachments of the semispinalis cervicis and multifidus muscles to the spinous processes are left untouched. It provides a conservative exposure through which a diverse range of posterior cervical surgeries can be performed. In contrast to conventional cervical approaches, none of the muscular attachments to the spinous processes is compromised. In this paper the author describes the technical details and discusses the applications of the procedure.

Use of the radial forearm microvascular free-flap graft for cranial base reconstruction

1999 ◽  
Vol 90 (4) ◽  
pp. 651-655 ◽  
Author(s):  
Marc S. Schwartz ◽  
James I. Cohen ◽  
Toby Meltzer ◽  
Michael J. Wheatley ◽  
Sean O. McMenomey ◽  
...  
Keyword(s):  
Skull Base ◽  
Free Flap ◽  
Cranial Base ◽  
Csf Leak ◽  
Content Type ◽  
Lateral Skull Base ◽  
Csf Leakage ◽  
Radial Forearm ◽  
Microvascular Free Flap ◽  
Fine Print

Object. Reconstruction of the cranial base after resection of complex lesions requires creation of both a vascularized barrier to cerebrospinal fluid (CSF) leakage and tailored filling of operative defects. The authors describe the use of radial forearm microvascular free-flap grafts to reconstruct skull base lesions, to fill small tissue defects, and to provide an excellent barrier against CSF leakage.Methods. Ten patients underwent 11 skull base procedures including placement of microvascular free-flap grafts harvested from the forearm and featuring the radial artery and its accompanying venae comitantes. Operations included six craniofacial, three lateral skull base, and two transoral procedures for various diseases. Excellent results were obtained, with no persistent CSF leaks, no flap failures, and no operative infections. One temporary CSF leak was easily repaired with flap repositioning, and at one flap donor site minor wound breakdown was observed. One patient underwent a second procedure for tumor recurrence and CSF leakage at a site distant from the original operation.Conclusions. Microvascular free tissue transfer reconstruction of skull base defects by using the radial forearm flap provides a safe, reliable, low-morbidity method for reconstructing the skull base and is ideally suited to “low-volume” defects.

Dermoid tumors of the spinal cord

1970 ◽  
Vol 33 (6) ◽  
pp. 676-681 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Complete Removal ◽  
Cord Compression ◽  
Conus Medullaris ◽  
Low Back ◽  
Content Type ◽  
Fine Print

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression. At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.

A multidisciplinary team approach to skull base chondrosarcomas

2001 ◽  
Vol 95 (2) ◽  
pp. 184-189 ◽  
Author(s):  
H. Alan Crockard ◽  
Anthony Cheeseman ◽  
Timothy Steel ◽  
Tamas Revesz ◽  
Janice L. Holton ◽  
...  
Keyword(s):  
Skull Base ◽  
Team Approach ◽  
Content Type ◽  
Mean Survival Time ◽  
Cranial Nerve Palsies ◽  
Slow Progression ◽  
The Mean ◽  
Skull Base Chordomas ◽  
Skull Base Chordoma ◽  
Fine Print

Object. The authors review their experience with treating skull base chondrosarcomas, which are much rarer than skull base chordomas and differ from them in prognosis and treatment. Methods. Seventeen patients (12 male and five female patients) with histologically verified chondrosarcomas were followed up prospectively over a 12-year period. The mean age at presentation was 35.9 years. Most patients presented with cranial nerve palsies. Seven had undergone surgery prior to referral to the authors' unit. All underwent maximum surgical cytoreduction by the most direct surgical approach; only the two patients harboring the mesenchymal variant underwent radiotherapy. Conclusions. One patient died of a pulmonary embolus; the patients harboring mesenchymal chondrosarcomas died at 20 and 36 months, respectively, after treatment. Of the remaining patients, 93% were alive 5 years postsurgery and had a projected 10-year survival rate of 84% (mean survival time 9.3 years). These data emphasize the very slow progression of this tumor compared with skull base chordoma.

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