Single Piece Cranio-Orbitozygomatic Approach, Trans Key Burr Hole Orbital Roof Osteotomy: A New Modification. Surgical Technique and Report of Eight Cases

Introduction: The aim of this study is to describe the general steps of the cranio- orbitozygomatic craniotomy approach, and to give a detailed description of the trans key burr hole orbital roof osteotomy modification of the approach.

Methods: The new surgical modification is applied to eight patients with skull base lesions in which cranio-orbitozygomatic approach was indicated. Seven cases are of sphenoid wing meningiomas with different extensions and one case is of tentorial meningioma extending to the middle cranial fossa. Trans key burr hole orbital roof osteotomy is described in details within the general steps of the cranio-orbitozygomatic approach.

Results: There were no complications related to the modification. One case was of mortality because of the massive pulmonary embolism and another case was of stiffness of temporomandibular joint. There were insignificant minor frontal base dura and periorbita tears. No relation between the modification and technique of surgery or the degree of exposure.

Conclusion: Trans key burr hole orbital roof osteotomy in single piece cranio-orbitozygomatic approach is surgically easy step that avoids excessive traction on the globe with no significant. The osteotomy helps to preserve the orbital roof preventing potential complications related to defective orbital floor such as pulsating exophthalmos.