Topographic anatomy of two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches: A comparative analysis of neurosurgical options

Cover Page

Cite item

Full Text

Abstract

Aim – to measure and compare the vertical and horizontal angles of attack on different intracranial surgical targets provided by the transzygomatic, modified orbitozygomatic and classic two-piece orbitozygomatic approaches, to determine the most optimal approaches to different surgical targets.

Material and methods. The study was conducted on 8 sides of en bloc specimens of human head and neck. The marking was performed with BrainLAB Kolibri navigational station (Germany) to highlight the surgical landmarks and measure the angles. The dissection was started macroscopically with standard instruments and photographic fixation of every stage of the approach. The craniotomy was performed with Stryker high speed drill (USA). After that, the microscopic stage was carried out with the ZEISS OPMI Vario/S88 surgical microscope (Germany). On each side, the following steps were completed: soft tissues dissection, cutting the zygomatic arch, fronto-temporal craniotomy, orbitozygomatic osteotomy, opening of the dura mater and dissection of structures of the cranial base, measurement of angles of attack with their apex located on skull base structures

Results. The angles of attack on different intracranial surgical targets were measured and compared for two-piece orbitozygomatic, modified orbitozygomatic and transzygomatic approaches.

Conclusion. The two-piece orbitozygomatic craniotomy is the most universal and optimal to approach the basilar artery bifurcation and lesions located in both anterior and middle cranial fossae. However, to minimize the surgical trauma and the risks of complications when exposing exclusively anterior cranial fossa, the modified orbitozygomatic approach is more adequate. When the lesion is small and located exclusively in middle cranial fossa, performing the transzygomatic approach is recommended.

About the authors

Semen A. Melchenko

Federal Center for Brain and Neurotechnologies

Email: dr.melchenko@yandex.ru
ORCID iD: 0000-0001-7060-0667

Neurosurgeon

Russian Federation, Moscow

Vasilii A. Cherekaev

Burdenko National Medical Research Center of Neurosurgery

Email: v.cherekaev@mail.ru
ORCID iD: 0000-0001-6881-7082

PhD, Professor, Neurosurgeon, Head of the Craniofacial Neurosurgery Department

Russian Federation, Moscow

Albert A. Sufianov

Federal Centre of Neurosurgery; I.M. Sechenov First Moscow State Medical University

Email: sufianovaa@mail.ru
ORCID iD: 0000-0001-7580-0385

Corresponding Member of RAS PhD, Professor, Neurosurgeon, Chief Physician

Russian Federation, Tyumen; Moscow

Vladimir N. Nikolenko

I.M. Sechenov First Moscow State Medical University; M.V. Lomonosov Moscow State University

Email: vn.nikolenko@yandex.ru
ORCID iD: 0000-0001-9532-9957

PhD, Professor, Head of the Department of Human Anatomy and Histology, Head of the Department of the Normal and Topographic Anatomy

Russian Federation, Moscow; Moscow

Grigorii E. Golodnev

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: grigoriigolodnev@gmail.com
ORCID iD: 0000-0002-3706-7749

Student

Russian Federation, Moscow

Tatyana S. Shumeiko

I.M. Sechenov First Moscow State Medical University

Email: Tanya.Shumeiko.2002@yandex.ru
ORCID iD: 0000-0001-9438-1278

Student

Russian Federation, Moscow

Marat R. Gizatullin

Federal Centre of Neurosurgery

Email: maratgizatullin@yandex.ru
ORCID iD: 0000-0002-6809-4694

Neurosurgeon

Russian Federation, Tyumen

Denis A. Golbin

Burdenko National Medical Research Center of Neurosurgery

Email: tech@nsi.ru
ORCID iD: 0000-0003-0017-2649

PhD, Neurosurgeon, Head of the Neurosurgical Anatomy and Biological Materials Conservation Laboratory

Russian Federation, Moscow

Nikolay V. Lasunin

Burdenko National Medical Research Center of Neurosurgery

Email: nikolay.lasunin@gmail.com
ORCID iD: 0000-0002-6169-4929

PhD, Neurosurgeon

Russian Federation, Moscow

Ivan S. Shelyagin

Federal Centre of Neurosurgery; I.M. Sechenov First Moscow State Medical University

Email: sheliagini@mail.ru
ORCID iD: 0000-0002-0877-7442

Neurosurgeon

Russian Federation, Tyumen; Moscow

Artem A. Surikov

Federal Centre of Neurosurgery; I.M. Sechenov First Moscow State Medical University

Email: surikovartem@gmail.com
ORCID iD: 0000-0002-7437-6137

Neurosurgeon

Russian Federation, Tyumen; Moscow

Ilya V. Senko

Federal Center for Brain and Neurotechnologies

Email: Senko.ilya@mail.ru
ORCID iD: 0000-0002-5743-8279

PhD, Neurosurgeon, Head of the Neurosurgery Department

Russian Federation, Moscow

References

  1. Pellerin P, Lesoin F, Dhellemmes P, et al. Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery. 1984;15(5):715-718. doi: 10.1227/00006123-198411000-00016
  2. Hakuba A, Liu S, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986;26(3):271-276.
  3. Zabramski JM, Kiriş T, Sankhla SK, et al. Orbitozygomatic craniotomy. Technical note. J Neurosurg. 1998;89(2):336-341. doi: 10.3171/jns.1998.89.2.0336
  4. Galzio RJ, Tschabitscher M, Ricci A. Orbitozygomatic Approach. In: Cappabianca P, Iaconetta G, Califano L, eds. Cranial, Craniofacial and Skull Base Surgery. Springer Milan; 2010:61-86. doi: 10.1007/978-88-470-1167-0_6
  5. Lemole GM, Henn JS, Zabramski JM, Spetzler RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg. 2003;99(5):924-930. doi: 10.3171/jns.2003.99.5.0924
  6. Chung YS, Gwak HS, Jung HW, et al. A cranio-orbital-zygomatic approach to dumbbell-shaped trigeminal neurinomas using the petrous window. Skull Base Off J North Am Skull Base Soc Al. 2001;11(3):157-164. doi: 10.1055/s-2001-16603
  7. Cherekaev VA, Kozlov AV, Muzyshev IA, et al. Results of surgical treatment of skull-base primary malignant tumors with intracranial invasion. Zhurnal Voprosy Neirokhirurgii Imeni N.N. Burdenko. 2019;83(5):31- 43. (In Russ.). [Черекаев В.А., Козлов А.В., Музышев И.А., и др. Результаты хирургического лечения первичных злокачественных опухолей основания черепа с интракраниальным распространением. Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко. 2019;83(5):31- 43]. doi: 10.17116/neiro20198305131
  8. Cherekaev VA, Gol'bin DA, Belov AI, et al. Orbitozygomatic approaches to skull base tumors spreading into the orbit, paranasal sinuses, nasal cavity, and pterygopalatine and infratemporal fossae. Zhurnal Voprosy Neirokhirurgii Imeni N.N. Burdenko. 2015;79(5):5-18. (In Russ., In Engl.). [Черекаев В.А., Гольбин Д.А., Белов А.И., и др. Орбитозигоматические доступы к опухолям основания черепа, распространяющимся в глазницу, околоносовые пазухи, полость носа, крылонебную и подвисочную ямки. Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко. 2015;79(5):5-18]. doi: 10.17116/neiro20157955-18
  9. 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(1):105-110. doi: 10.1097/00006123-199101000-00016
  10. Yağmurlu K, Kalani MYS. Modified Orbitozygomatic Craniotomy for Clipping of a Ruptured Thrombotic A1-A2 Aneurysm. World Neurosurg. 2022;166:18. doi: 10.1016/j.wneu.2022.07.003
  11. Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987;21(4):474-477. doi: 10.1227/00006123-198710000-00006
  12. Samy LL, Girgis IH. Transzygomatic Approach for Nasopharyngeal Fibromata with Extrapharyngeal Extension. J Laryngol Otol. 1965;79(9):782-795. doi: 10.1017/S0022215100064379
  13. Badwal JS. Transzygomatic Approach to Skull Base: History, Evolution, and Possibility of a Simple Modification. J Craniofac Surg. 2016;27(3):e293-295. doi: 10.1097/SCS.0000000000002538
  14. Oikawa S, Mizuno M, Muraoka S, Kobayashi S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy: Technical note. J Neurosurg. 1996;84(2):297-299. doi: 10.3171/jns.1996.84.2.0297

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure 1. Soft tissues dissection. 1A – skin incision. 1Б – subfascial dissection of the temporalis fascia with preservation of fronto-temporal branch of the facial nerve. 1B – reflecting the aponeurotic flap with superficial and deep temporalis fascia. 1Г – corpus, frontal and temporal processes of zygomatic bone, zygomatic process of temporal bone and zygomatic process of frontal bone are exposed.

Download (3MB)
Indexing metadata
3. Figure 2. Bone work. 2A – cuts in the zygomatic arch. 2Б – fronto-temporal craniotomy. 2B – cut through the lateral wall of the orbit down to the inferior orbital fissure. 2Г – bone cut through the roof of the orbit. 2Д – the arrow highlights two bone cuts going through the roof and lateral wall of the orbit connecting lateral aspects of superior and inferior orbital fissures.

Download (4MB)
Indexing metadata
4. Figure 3. Surgical view after completed two-piece orbitozygomatic approach and skull base dissection of surgical targets to measure the angles of attack. 3A – anatomical specimen. 3Б – illustration.

Download (2MB)
Indexing metadata
5. Figure 4. Skull base structures (surgical targets) which served as apexes for measuring of angles of the attack. A, Б – anatomic specimen, B – illustration. 1 – ipsilateral anterior clinoid process, 2 – bifurcation of the ipsilateral supraclinoid internal carotid artery, 3 – bifurcation of the ipsilateral middle cerebral artery, 4 – ipsilateral oculomotor (CN III) nerve triangle, 5 – superior bifurcation of the basilar artery.

Download (3MB)
Indexing metadata
6. Figure 5. Zygomatic arch is returned to evaluate the angles of attack in modified (supraorbital) one-piece orbitozygomatic approach. A – temporalis muscle is returned and the zygomatic arch is put back; Б – temporalis muscle is reflected towards skull base, the conditions to measure the angles of attack in supraorbital approach are created.

Download (3MB)
Indexing metadata
7. Figure 6. Supraorbital bone flap is returned and the zygomatic arch is removed to evaluate the angles of attack in transzygomatic approach.

Download (2MB)
Indexing metadata
8. Figure 7. A joint diagram of comparison of the vertical angles of attack on the surgical targets on the cranial base in two-piece orbitozygomatic approach, transzygomatic approach and modified orbitozygomatic approach.

Download (253KB)
Indexing metadata
9. Figure 8. A joint diagram of comparison of the horizontal angles of attack on the surgical targets on the cranial base in two-piece orbitozygomatic approach, transzygomatic approach and modified orbitozygomatic approach.

Download (271KB)
Indexing metadata

Copyright (c) 2023 Melchenko S.A., Cherekaev V.A., Sufianov A.A., Nikolenko V.N., Golodnev G.E., Shumeiko T.S., Gizatullin M.R., Golbin D.A., Lasunin N.V., Shelyagin I.S., Surikov A.A., Senko I.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).