J Neurol Surg B Skull Base 2016; 77 - P114
DOI: 10.1055/s-0036-1580060

Single Piece Cranio-Orbito-Zygomatic Approach, Trans Key Burrhole Orbital Roof Osteotomy; A New Modification. Surgical Technique and Report of Eight Cases

Mohamed A. Mohamed Ismail 1, 2
  • 1Ain Shams University, Cairo, Egypt
  • 2Saudi German Hospitals KSA, Riyadh, Saudi Arabia

Background: Cranio-orbito-zygomatic (COZ) approach is a common skull base approach. Many modifications for this approach evolved describing different cuts of the osteotomies and tailoring according to the lesions. Objectives: The aim of this study is to describe the general steps of the cranio- orbito-zygomatic craniotomy approach, and to give a detailed description of the trans key burrhole orbital roof osteotomy modification of the approach.

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

Results: There were no complications related to the modification, one case of mortality due to massive pulmonary embolism and another case of stiffness of temporomandibular joint. There were minor frontal base dura and periorbita tears with no consequences. 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-orbito-zygomatc approach is surgically easy step that avoid excessive traction on the globe with no major complications. The osteotomy helps to preserve the orbital roof preventing potential complications related to defective orbital floor like pulsating exophthalmos.