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Reshaping the zygomatic complex: A "small step" in frontotemporal craniotomy and a "big leap" in exposure
Shashwat Mishra1, Arun K Srivastava, Hitesh Kumar
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Context:
Pterional or fronto-temporal craniotomy, developed by Prof. M. G. Yasargil, is among the most familiar skull base surgery techniques. The cranio-orbito zygomatic (COZ) approach evolved to address the significant limitations of the pterional exposure in excising some parasellar lesions. Although extremely versatile, the COZ technique involves extensive dissection of the cranio-facial soft tissue and reconstruction towards the end of the procedure. The zygomatic reshaping is a minor modification of the pterional approach, which enhances the exposure possible through the classical approach and often circumvents the need for an orbito-zygomatic osteotomy.
Aims:
To demonstrate the technique of reshaping of the zygomatic complex for an optimum surgical exposure and cosmetic results.
Materials And Methods:
Between April 2013 and December 2014, 8 patients with various middle and anterior skull base lesions were operated using this technique. These patients form the clinical material for this study. The clinical details, radiological images and follow-up data of these patients were collected for this clinical series.
Results:
No mortality or significant morbidity were noted in this series. The post-operative cosmetic results were also acceptable.
Conclusions:
A quick and easy modification of the classical pterional approach through zygomatic reshaping has the potential to provide a significantly enhanced surgical exposure for parasellar lesions. Using this approach, it might be possible to avoid an extensive orbito-zygomatic osteotomy in suitable lesions.
