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.

[1]  C. Hadjipanayis,et al.  The history of neurosurgery and its relation to the development and refinement of the frontotemporal craniotomy. , 2014, Neurosurgical focus.

[2]  A. Franzin,et al.  Management of spheno-orbital en plaque meningiomas: clinical outcome in a consecutive series of 40 patients , 2013, British journal of neurosurgery.

[3]  W. Couldwell,et al.  The frontotemporal (pterional) approach: an historical perspective. , 2012, Neurosurgery.

[4]  M. Losa,et al.  Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas , 2012, Clinical Neurology and Neurosurgery.

[5]  S. Agazzi,et al.  The frontotemporal-orbitozygomatic approach: reconstructive technique and outcome , 2012, Acta Neurochirurgica.

[6]  M. Riva,et al.  Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series. , 2011, Journal of neurosurgery.

[7]  F. Gagliardi,et al.  Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients , 2011, Acta Neurochirurgica.

[8]  M. McDermott,et al.  A surgical modification for performing orbitozygomatic osteotomies: technical note , 2010, Neurosurgical Review.

[9]  Paolo Cappabianca,et al.  Cranial, craniofacial and skull base surgery , 2010 .

[10]  N. Selden,et al.  Modified orbitozygomatic craniotomy for craniopharyngioma resection in children. , 2009, Journal of neurosurgery. Pediatrics.

[11]  S. Behari,et al.  Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms. , 2009, Neurology India.

[12]  M. Başkaya,et al.  The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. , 2008, Neurosurgical focus.

[13]  Jung-Shun Lee,et al.  Orbitozygomatic approach for excisions of orbital tumors with 1 piece of craniotomy bone flap: 2 case reports. , 2007, Surgical neurology.

[14]  M. Losa,et al.  SURGICAL TREATMENT OF GIANT PITUITARY ADENOMAS: STRATEGIES AND RESULTS IN A SERIES OF 95 CONSECUTIVE PATIENTS , 2007, Neurosurgery.

[15]  Kafatabani Lezyonlarina,et al.  Orbitozygomatic Approach To Skull Base Lesions , 2007 .

[16]  E. Elazab,et al.  The arterial supply of the temporalis muscle , 2006, Surgical and Radiologic Anatomy.

[17]  M. Kawashima,et al.  One-piece Versus Two-piece Orbitozygomatic Craniotomy: Quantitative and Qualitative Considerations , 2006, Neurosurgery.

[18]  A. Agur,et al.  The Orbitozygomatic Approach , 2006, Neurosurgery.

[19]  M. Yașargil,et al.  Microsurgery: Applied to Neurosurgery , 2006 .

[20]  G. Sanuş,et al.  Cranio-orbitozygomatic Approach and Its Orbitopterional Modification: Microsurgical Anatomy and Surgical Technique , 2006 .

[21]  J. Delashaw,et al.  Modified osteoplastic orbitozygomatic craniotomy. Technical note. , 2005, Journal of neurosurgery.

[22]  K. Schaller,et al.  The combined pterional and orbitocygomatic approach to extensive tumours of the lateral and latero-basal orbit and orbital apex , 2005, Acta Neurochirurgica.

[23]  M. Sindou,et al.  Fronto-temporal approach with orbito-zygomatic removal surgical anatomy , 2005, Acta Neurochirurgica.

[24]  O. Al-Mefty,et al.  The anatomical basis for surgical preservation of temporal muscle. , 2004, Journal of neurosurgery.

[25]  F. G. Jazo.  New orbitozygomatic approach by craniotomy , 2004, Child's Nervous System.

[26]  R. Spetzler,et al.  Modifications to the orbitozygomatic approach. Technical note. , 2003, Journal of neurosurgery.

[27]  R. Delfini,et al.  Fronto-temporo-orbito-zygomatic approach and variants. Surgical technique and indications. , 2003, Journal of neurosurgical sciences.

[28]  P. Mortini,et al.  Transcranial approaches to pituitary tumors , 2002 .

[29]  Y. Hirashima,et al.  One-piece pedunculated frontotemporal orbitozygomatic craniotomy by creation of a subperiosteal tunnel beneath the temporal muscle: technical note. , 2002, Neurosurgery.

[30]  A. Nanda,et al.  Anatomical study of the orbitozygomatic transsellar-transcavernous-transclinoidal approach to the basilar artery bifurcation. , 2002, Journal of neurosurgery.

[31]  H. van Loveren,et al.  The One-Piece Orbitozygomatic Approach: The MacCarty Burr Hole and the Inferior Orbital Fissure as Keys to Technique and Application , 2002, Acta Neurochirurgica.

[32]  M. Sindou,et al.  Respective Indications for Orbital Rim, Zygomatic Arch and Orbito-Zygomatic Osteotomies in the Surgical Approach to Central Skull Base Lesions. Critical, Retrospective Review in 146 Cases , 2001, Acta Neurochirurgica.

[33]  S. Gupta,et al.  Single flap fronto-temporo-orbito-zygomatic craniotomy for skull base lesions. , 2001, Neurology India.

[34]  S. Gupta,et al.  Bilateral fronto-orbito-zygomatic craniotomy--a combined extended frontal and orbitozygomatic approach. , 2000, Neurology India.

[35]  紀彦 玉木,et al.  Fronto-temporal approach with orbito-zygomatic removalにより一期的クリッピング術を施行した多発性脳動脈瘤の1例 , 2000 .

[36]  R. Spetzler,et al.  Subfascial and submuscular methods of temporal muscle dissection and their relationship to the frontal branch of the facial nerve. Technical note. , 2000, Journal of neurosurgery.

[37]  T. Shigeno,et al.  Orbitozygomatic approach by transposition of temporalis muscle and one-piece osteotomy. , 1999, Surgical neurology.

[38]  D. Pieper,et al.  Cranio-orbito-zygomatic approach , 1999 .

[39]  R. Spetzler,et al.  Orbitozygomatic craniotomy. Technical note. , 1998, Journal of neurosurgery.

[40]  A. Spallone,et al.  Fronto-orbito zygomatic approach: a technical modification. , 1996, Skull base surgery.

[41]  J.‐P. Lee,et al.  Orbitozygomatic infratemporal approach to lateral skull base tumors , 1993, Acta neurologica Scandinavica.

[42]  L. Sekhar,et al.  The extended frontal approach to tumors of the anterior, middle, and posterior skull base. , 1992, Journal of neurosurgery.

[43]  A. Quaroni.  Zygomatic approach to skull base lesions , 1991 .

[44]  M. Hashimoto,et al.  Orbitozygomatic temporopolar approach for a high basilar tip aneurysm associated with a short intracranial internal carotid artery: a new surgical approach. , 1991, Neurosurgery.

[45]  P. Donald.  History of skull base surgery. , 1991, Skull base surgery.

[46]  R. R. Smith,et al.  Tailoring the cranio-orbital approach. , 1990, The Keio journal of medicine.

[47]  Monkhouse Ws.  The anatomy of the facial nerve. , 1990 .

[48]  R. Spetzler,et al.  Reconstruction of the temporalis muscle for the pterional craniotomy. Technical note. , 1990, Journal of neurosurgery.

[49]  M. Sindou,et al.  [Orbital and/or zygomatic removal in an approach to lesions near the cranial base. Surgical technic, anatomic study and analysis of a series of 24 cases]. , 1990, Neuro-Chirurgie.

[50]  W. Monkhouse.  The anatomy of the facial nerve. , 1990, Ear, nose, & throat journal.

[51]  Professor Dr. med. Prof. h.c. Madjid Samii,et al.  Surgery of the Skull Base , 1989, Springer Berlin Heidelberg.

[52]  O. Al-Mefty.  Supraorbital-pterional approach to skull base lesions. , 1987, Neurosurgery.

[53]  M. Yașargil,et al.  Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. , 1987, Journal of neurosurgery.

[54]  O. Al-Mefty.  Skull base: zygomatic approach. , 1986, Neurosurgery.

[55]  A. Hakuba,et al.  The orbitozygomatic infratemporal approach: a new surgical technique. , 1986, Surgical neurology.

[56]  Shu-shan Liu,et al.  The Orbitozygomatic Infratemporal Approach: Technique A New Surgical , 1986 .

[57]  D. Long,et al.  Visual function following optic canal decompression via craniotomy. , 1985, Journal of neurosurgery.

[58]  P. Pellerin,et al.  Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. , 1984, Neurosurgery.

[59]  L. L. Mcarthur.  AN ASEPTIC SURGICAL ACCESS TO THE PITUITARY BODY AND ITS NEIGHBORHOOD , 1912 .