Use of an Ultrasonic Osteotome for Orbitozygomatic Craniotomies

Background: The orbitozygomatic craniotomy is a standard approach used to treat skull base pathology. Various options exist to create the osteotomies including use of osteotomes, sagittal saw, and craniotome footplates. A novel ultrasonic osteotome has been utilized in spine surgery to create osteotomies as thin as 0.5mm while minimizing the risk of damage to soft tissues. We sought to evaluate its use in skull base surgery, which had not been previously reported.

Methods: A retrospective review was conducted of patients undergoing a two-piece orbitozygomatic craniotomy at the Johns Hopkins Hospital between November 2009 and March 2013. Patients were included if osteotomies were made utilizing an ultrasonic osteotome. Complications related to the approach were noted.

Results: A total of six patients met inclusion criteria for this study. The average age was 53.2 years. Patients were followed for an average of 375 days (52–1293 days). There were no cases of periorbital violation, enophthalmos, or orbital hematoma. Post-operative imaging showed the cuts were well opposed.

Conclusion: Use of an ultrasonic osteotome allows for precise cuts under direct supervision with minimal risk to critical adjacent structures in our cohort of patients undergoing a two-piece orbitozygomatic craniotomy. The ultrasonic osteotome appears to be a safe instrument for osteotomy creation in skull base approaches.

Fig. 1 Axial post-operative CT of a patient who initially underwent a right orbitozygomatic approach for resection of a craniopharyngioma and subsequently underwent a left orbitozygomatic approach for tumor recurrence. The difference in a traditional craniotome osteotomy (red arrow) and those created with the ultrasonic osteotome (white arrows) is appreciated.