Modified Orbitozygomatic (Orbitopterional) Approach for Suprasellae Tumors

The authors evaluated the clinical and radiological outcome including surgical complications after suprasellae tumor removal using a modified orbitozygomatic approach. Tumor resection via modified orbitozygomatic approach was performed in 19 patients with large suprasellae tumors including tuberculum sellae meningioma (n = 10) and craniopharyngioma (n = 9). The authors retrospectively analyzed clinical data, radiological findings, and outcomes. Visual acuity and visual field were assessed both preoperatively and 6-months postoperatively. Approach-related complications were determined at an early postoperative period and at 6 months based on the Karnofsky performance scale score (KPS), leakage of CSF, endocrinological status, and infections. Gross-total removal was achieved in 16 patients (84%). Among 19 patients, preoperative visual deficit was improved in 12, unchanged in 5 and worsened in 2 patients. At 6 months postoperatively, all patients had a good recovery (KPS > 90). During the follow-up period, tumor recurred in three patients (one; meningioma, two; craniopharyngioma). On the follow-up MRI, surgery-related lesions were observed in one patient. In all patients, we do not need to use retractor systems, only using natural gravity. The approach appears to be effective in resolving the clinical symptoms including visual deterioration without inducing surgical injury on the brain surface. The approach is an alternative surgical technique to resect suprasellae tumors.