CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(S 01): S1-S332
DOI: 10.1055/s-0038-1672357
Oral Presentation – Anatomy & Approaches
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

The Mini-Modified Orbitozygomatic and Supraorbital Approaches Anatomical Comparison

Eberval Gadelha Figueiredo
1   Neurosurgery Department, Universidade de São Paulo, São Paulo
,
Nicollas Nunes Rabelo
1   Neurosurgery Department, Universidade de São Paulo, São Paulo
,
Puspha Deshmukh
2   Division of Neurological Surgery, Barrow Neurological Institute, Phoenix
,
Peter Nakaji
2   Division of Neurological Surgery, Barrow Neurological Institute, Phoenix
,
Neil Crawford
2   Division of Neurological Surgery, Barrow Neurological Institute, Phoenix
,
Robert F. Spetzler
2   Division of Neurological Surgery, Barrow Neurological Institute, Phoenix
,
Mark C. Preul
2   Division of Neurological Surgery, Barrow Neurological Institute, Phoenix
,
Bruno Braga Sisnando da Costa
1   Neurosurgery Department, Universidade de São Paulo, São Paulo
› Author Affiliations
Further Information

Publication History

Publication Date:
06 September 2018 (online)

 

Seven sides of cadaver heads were used to compare the surgical exposures provided by the mini-modified orbitozygomatic (MOz) and supraorbital (SO) approaches. The Optotrak 3020 computerized tracking system (Northern Digital, Waterloo, ON, Canada) was utilized to evaluate the area of anatomical exposure defined by six points: (1) ipsilateral sphenoid ridge; (2) most distal point of the ipsilateral middle cerebral artery (MCA); (3) most distal point of the ipsilateral posterior cerebral artery (PCA); (4) most distal point of the contralateral PCA; (5) most distal point of the contralateral MCA; and (6) contralateral sphenoid ridge. Additionally, angles of approach for the ipsilateral MCA bifurcation, ipsilateral ICA bifurcation, basilar artery tip, contralateral MCA and ICA bifurcation and anterior communicating artery (AcomA) were evaluated, first for SO and then for MOz. An image guidance system was used to evaluate the limits of surgical exposure. No differences in the area of surgical exposure were noted (p > 0.05). Vertical angles were significantly wider for the ipsilateral and contralateral ICA bifurcation, AcomA, contralateral MCA and basilar tip (p < 0.05) for MOz. No differences in horizontal angles were observed between the approaches for the six targets (p > 0.05). There were no differences in the limits of exposure. MOz affords no additional surgical working space. However, our results demonstrate systematically that vertical exposure is improved. The MOz should be performed while planning an approach to these regions and a wider exposure in the vertical axis is needed.