The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications.
The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications.
复制标题
颅底手术的主力：眶颧入路。
作者：
H. Seçkin;E. Avcı;K. Uluc;D. Niemann;M. Başkaya
对象
本研究的目的是描述眶颅开颅手术的显微解剖及其改进，并详细说明颞肌筋膜和肌肉的逐步解剖，并解释这些方法中涉及的开颅技术。
方法
9具尸体头部注射彩色硅胶，以展示逐步解剖的3种不同的眶颅瓣开颅术。使用标准手术器械进行开颅和解剖，并在显微镜放大和照明下研究显微外科解剖。
结果
作者分别在3个尸头上进行了2件式、1件式和眶上眶颅开颅术。显示颞肌筋膜和肌肉的逐步解剖以及截骨切口，并在尸体头部中展示前颅窝和中颅窝的相关显微外科解剖。手术病例也被提出来证明的应用和适应症的眶颅眶入路。
结论
眶颅正中入路可进入前颅窝和中颅窝以及鞍深和基底尖区。增加颅底的骨切除量，避免了剧烈的脑牵开，并提供了改进的多角度轨迹和更浅的手术野。对眶颅眶入路的改进提供了可针对特定病变量身定制的替代方案，使外科医生能够在每个病例中使用最佳技术，而不是“一刀切”的方法。
OBJECT
The aim of this study was to describe the microsurgical anatomy of the orbitozygomatic craniotomy and its modifications, and detail the stepwise dissection of the temporalis fascia and muscle and explain the craniotomy techniques involved in these approaches.
METHODS
Nine cadaveric embalmed heads injected with colored silicone were used to demonstrate a stepwise dissection of the 3 variations of orbitozygomatic craniotomy. The craniotomies and dissections were performed with standard surgical instruments, and the microsurgical anatomy was studied under microscopic magnification and illumination.
RESULTS
The authors performed 2-piece, 1-piece, and supraorbital orbitozygomatic craniotomies in 3 cadaveric heads each. Stepwise dissection of the temporalis fascia and muscle, and osteotomy cuts were shown and the relevant microsurgical anatomy of the anterior and middle fossae was demonstrated in cadaveric heads. Surgical case examples were also presented to demonstrate the application of and indications for the orbitozygomatic approach.
CONCLUSIONS
The orbitozygomatic approach provides access to the anterior and middle cranial fossae as well as the deep sellar and basilar apex regions. Increased bone removal from the skull base obviates the need for vigorous brain retraction and offers an improved multiangled trajectory and shallower operative field. Modifications to the orbitozygomatic approach provide alternatives that can be tailored to particular lesions, enabling the surgeon to use the best technique in each individual case rather than a "one size fits all" approach.