Single Peice Cranioorbitozygomatic Osteotomy with Trans Key Whole Orbital Osteotomy a Surgical Modification

Anterior skull base tumors are very challenging in approach. all skull base approaches aim to provide best exposure with minimal brain retraction. Cranio-orbito-zygomatic approach (COZ) is a popular technique with many modification. The orbital osteotomy in the single piece technique is very challenging and provide both challenge in protecting the globe as well as the anterior base dura. This work shows a new surgical modification by which the orbital osteotomy done under vision with better protection of these structures. This new modification in the standard steps of COZ allows using simple tools to make a controlled cut of the orbital roof, allowing for preservation of orbital roof bones and avoid potential adverse effect of orbital roof bone loss. This work demonstrates the standard steps of the single peice COZ approach with percise description of the new modifications .