Abstract
The orbitopterional approach provides an excellent combination of basal access and
suprasellar access. This approach also allows for less brain retraction when resecting
larger suprasellar tumors that are more superiorly projecting due to a more frontal
and inferior trajectory. In this operative video, the authors thoroughly detail an
orbitopterional craniotomy utilizing a one-piece modified orbitozygomatic technique.
This technique involves opening the craniotomy through a standard pterional incision.
The craniotomy is performed using the standard three burr holes of a pterional approach;
however, the osteotomy is extended anteriorly through the frontal process of the zygomatic
bone as well as through the supraorbital rim. In this operative video atlas, the authors
illustrate the operative anatomy, as well as surgical strategy and techniques to resect
a large suprasellar craniopharyngioma in a 4-year-old male. Other reasonable approach
options for a lesion of this size would include a standard pterional approach, a supraorbital
approach, or expanded endoscopic transsphenoidal approach. The lesion was quite high
and thus, the supraorbital approach may confine access to the superior portion of
the tumor. While recognizing that some groups may have chosen the endoscopic expanded
transsphenoidal approach for this lesion, the authors describe more confidence in
achieving the goal of a safe and maximal resection with the orbitopterional approach.
The link to the video can be found at: https://youtu.be/eznsK16BzR8.
Keywords
craniopharyngioma - orbitopterional - pediatric neurosurgery - suprasellar mass -
orbitozygomatic
