One-piece pedunculated frontotemporal orbitozygomatic craniotomy by creation of a subperiosteal tunnel beneath the...

We have developed a simple and easy modification of the orbitozygomatic approach using one-piece pedunculated craniotomy. This modification prevents atrophy of the temporal muscle, resulting in temporal fossa depression and atrophy of the free bone graft resulting in the occurrence of bone pits along the line of the craniotomy.

The key points of this modification are as follows. The scalp flap is elevated in the plane between the superficial and deep layers of the temporal fascia. The temporal muscle is dissected from the temporal plane by performing subperiosteal elevation with intact insertion to the superior temporal line of the temporal muscle, which results in the creation of a subperiosteal tunnel beneath the temporal muscle. The one-piece fronto-orbitozygomatic bone flap is hinged on the temporal muscle.

After the surgeons had received full training in the procedures and anatomic findings related to this craniotomy in 10 cadaveric heads, surgery was performed for paraclinoid or parasellar tumors in five patients. Although temporary pulsatile exophthalmos occurred after surgery in one patient, no craniotomy-related complications occurred during or after surgery. Because the bone flap is fragile at the frontozygomatic suture, fixation with a small titanium plate was required in three of five patients at the end of the operation. All patients were pleased with the cosmetic results of surgery during a minimum follow-up period of 6 months.

The modifications described in this article reduce the risk of atrophy of the temporal muscle and improve the cosmetic results without limitation of operative exposure.